From Clinical Practice to Basic Science, in Search for the Ideal Implantable Bioreactor: A Review on MFAT (Micro-Fragmented Adipose Tissue—Lipogems®) Biology and Its Clinical Applications

The therapeutic use of adipose tissue has evolved from volumetric replacement to biologically driven regenerative applications. This brief review analyzes micro-fragmented adipose tissue (MFAT), obtained through Lipogems® technology, as a paradigmatic example of reverse translation in regenerative medicine, where consistent clinical efficacy preceded and guided mechanistic investigation. Unlike enzymatic digestion or aggressive mechanical emulsification (nanofat), Lipogems® device processing preserves the native stromal vascular niche, including extracellular matrix architecture and the pericyte–endothelial complex. We review the biological mechanisms underlying MFAT activity, compare MFAT with stromal vascular fraction (SVF) and nanofat, summarize consolidated clinical evidence across multiple medical and surgical specialties, and discuss emerging translational applications in oncology and sepsis. Collectively, the available data position MFAT as a structurally intact, biologically responsive tissue bioreactor bridging clinical practice and regenerative biology.