Pre-enrichment of adipose tissue grafts: Potential and limitations

Autologous adipose tissue grafts are commonly used by plastic and aesthetic surgeons in various medical procedures for soft-tissue augmentation and reconstruction. However, a significant portion of the transplanted fat is absorbed in the injection site, resulting in inconsistent outcomes. Low retention of the transplanted fat often requires multiple fat graft sessions to obtain satisfactory results, making the fat graft procedure expensive. Recently, alternative strategies have been conceived to enhance the survival of transplanted fat for more consistent results and greater patient satisfaction. Pre-enrichment of autologous fat grafts with regenerative cells is one alternative procedure for making the outcomes more consistent. During the processing of the adipose tissue, regenerative cells can be obtained as a stromal vascular fraction (SVF) or as ex vivo expanded fat-derived stem cells (ASCs). Pre-enrichment of the fat grafts with either SVF or ASCs can be used as an alternative method to increase the viability of fat grafts. However, there are controversies as to the potential advantages and drawbacks. Fundamental questions concerning the best type and number of cells for pre-enrichment of the fat grafts still need to be answered. This chapter focuses on multiple pre-enrichment strategies to enhance long-term fat retention and make the clinical outcome more reliable. Further, the pre-enrichment strategies' potential, safety, and limitations will be discussed. This information is essential to assist clinicians in using the optimal cell type and number for enhanced outcomes and patient satisfaction.