Translational considerations for adipose-derived biological scaffolds for soft tissue repair

Restoration of soft tissue defects relies on proper structural support and bioactive components to instruct remodeling processes that have tightly controlled spatial and temporal activity not yet fully understood. One clinical mainstay for soft tissue reconstruction, autologous fat grafting, has widespread use in reconstructive and esthetic surgeries owing to the success of liposuction techniques in the 1980s and standardization of adipose processing in the 1990s. Although widespread, clinical outcomes are unpredictable owing to significant variation in fat resorption rates (25–80%) [1–4] and a lack of assays to predict outcomes or confirm cell viability preoperatively. Autologous fat grafting has a few limitations that have fueled the development of off-the-shelf technologies using tissue engineering approaches. Acellular human tissue products have an opportunity to meet this significant clinical unmet need. Selected recent strategies in acellular adipose tissue products for soft tissue reconstruction will be reviewed here. These advancements will inform further development for soft tissue reconstruction.