Autologous fat grafting is the main surgical technique for soft tissue reconstruction. However, its clinical use with more extended volumes is limited by repeated procedures due to the little possibility of banking tissue, donor-site morbidity and unpredictable graft resorption rates. To overcome these problems, adipose tissue engineering has focused on developing injectable scaffolds. Most of them are hydrogels that closely mimic the biological, structural and mechanical characteristics of native adipose tissue. This review provides an overview of current injectable scaffolds designed to restore soft tissue volume defects, emphasizing their translational potential and future directions. Natural injectable scaffolds exhibit excellent biocompatibility but degrade rapidly and lack mechanical strength. Synthetic injectable scaffolds provide tunable elasticity and degradation rates but require biofunctionalization to support cell adhesion and tissue integration. Adipose extracellular matrix-derived injectable scaffolds are fabricated by decellularization of adipose tissue. Accordingly, they combine bio-mimetic structure with intrinsic biological cues that stimulate host-driven adipogenesis and angiogenesis, thus representing a translatable “off-the-shelf” alternative to autologous fat grafting. However, despite this broad spectrum of available injectable scaffolds, the establishment of clinically reliable soft tissue substitutes capable of supporting large-volume and long-lasting soft tissue reconstruction still remains an open challenge.

The exposure of endothelial cells to high glucose concentrations promotes angiogenesis. The present study investigated whether this pro-angiogenic effect of glucose is suitable to improve the capability of nanofat to vascularize implanted dermal substitutes. Nanofat was processed from white adipose tissue originating from green fluorescent protein (GFP)⁺ C57BL/6J donor mice and incubated for 1 h in Hank’s Balanced Salt Solution with or without (control) a high level of glucose (30 mM). The pretreated nanofat was seeded onto dermal substitutes, which were analyzed by intravital fluorescence microscopy, histology and immunohistochemistry in dorsal skinfold chambers of GFP⁻ C57BL/6J mice to assess their vivo performance over a period of 14 days. A high level of glucose-pretreated nanofat did not induce a stronger immune response when compared to the control. However, it improved the vascularization of the implants, as shown by a significantly higher density of blood-perfused microvessels in the border zones (~3.6-fold increase) and more CD31⁺/GFP⁺ microvessels (~3-fold increase) inside the implants. Accordingly, high glucose-pretreated nanofat levels also enhanced the tissue integration of the dermal substitutes, as indicated by the deposition of more type I collagen (~2.9-fold increase). These findings suggest that the short-term exposure of nanofat to a high level of glucose represents a promising and clinically feasible strategy to enhance its regenerative properties when seeded onto dermal substitutes.

Capsular contracture (CC) is the most common complication following implant-based breast surgery. It results from a dysregulated foreign body response characterized by inflammation and fibrosis. Effective strategies in the management of CC remain limited. Autologous fat grafting (AFG) is a promising alternative to current approaches due to its regenerative and immunomodulatory properties. This review provides an overview of the current understanding of CC pathophysiology and consolidates preclinical and clinical evidence on the influence of AFG on this pathogenic condition. Preclinical studies use both conventional AFG and isolated adipose-derived stem cells to prevent CC. They consistently demonstrate attenuated capsule formation and reduced inflammatory response. Clinical evidence suggests that AFG reduces both the incidence and recurrence of CC. This is also the case in the high-risk setting of previously irradiated breasts. Therefore, AFG may act as more than a purely volumetric reconstructive technique by modulating the foreign body response and improving capsule characteristics. Emerging strategies in implant-based breast surgery include the improvement of fat graft viability as well as immunomodulatory and bioengineering-based approaches. Overall, AFG appears to be feasible and effective in the management of CC. However, standardized protocols and additional long-term outcomes are required to ensure safe implementation in clinical practice.

Background: Patients with symptomatic abdominal tissue excess following massive weight loss (MWL) often experience skin affections associated with hygiene challenges, functional impairments, and psychological distress, all of which significantly impact their quality of life (QoL). Abdominoplasty effectively addresses these issues when conservative treatments prove ineffective. However, health insurance companies (HICs) in Switzerland frequently deny reimbursement. This study aimed to evaluate HIC’s reimbursement policies for abdominoplasty, quantifying time delays and additional costs generated by reconsideration due to initial rejections while assessing postoperative QoL of patients. Methods: A retrospective cohort study was conducted including patients undergoing abdominoplasty for symptomatic abdominal tissue excess after MWL between July 2019 and December 2023. Eligibility required HIC approval, informed consent, and legal age. Primary outcomes measured the number of reimbursement requests needed per patient, duration until approval, and additional diagnostic and therapeutic interventions following rejection. Secondary outcomes focused on additional consequent costs, differences in baseline characteristics and symptomatology, as well as QoL improvements using a non-validated, study-specific questionnaire. Results: Of 52 patients included, 33 received cost approval after a single request, whereas 19 required multiple submissions. The mean duration until approval was 15 weeks, with a 26-week delay for the multiple-request group, generating additional costs of CHF 715 per patient. Moreover, abdominoplasty significantly improved QoL in all patients, with no differences between groups. Conclusions: Initial reimbursement denials caused treatment delays, prolonged symptomatology, and increased healthcare costs, despite clear surgical indications. However, future studies involving larger cohorts are needed to support these findings.