In reconstructive surgery, there is a tremendous clinical need for adequate implants to repair soft tissue defects resulting from traumatic injury, tumor resection, or congenital anomalies. Adipose tissue engineering holds the promise to provide answers to this still increasing demand. The current approaches to adipose tissue engineering are comprehensively reviewed detailing the different cell carriers under investigation. A special focus is put on the applied cells. The delivered mesenchymal stem cells act in a dual role as building block of the new tissue and modulators of the host response. The conditioning of the cells in vitro prior to implantation decisively influences the tissue development and long-term survival in vivo. The special role of vascularization in adipose engineering is discussed. In all parts, key messages are defined providing the base for future advances in the generation of fat substitutes.
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