Purpose: Immediate autologous fat grafting (AFG) is a volume replacement technique that is used at the time of breast conservation surgery (BCS). Although there is reported experience from Europe and South America, there has yet to be reported Australian experience. This study evaluates the operative and short-term oncologic outcomes of this technique, and describes patient, breast and disease factors associated with its utilisation. Methodology: A retrospective review of demographic, operative and oncologic data for consecutive cases of immediate AFG by a single surgeon was completed. Results: There were sixty cases between Feb 2021 and Dec 2022, with a median age of 53.9 (range, 26-84). Immediate AFG was primarily used in patients with C cup breast size (n=17, 27.90%) and upper inner quadrant tumours (n=29, 47.50%). Luminal A subtype (n=24, 39.30%) was the most common cancer biology. Mean cancer size and weight were 25.5mm (range, 1.8-105mm) and 28.1g (range 4 - 223g), respectively. Lipo-harvesting was mainly from the abdomen (n=54, 88.50%) with mean harvest volume 90.2ml (range, 20-350) and mean fill volume 62.4ml (range, 12-370ml). One-third of cases had further surgery to achieve margin clearance. One patient had an operative complication (seroma) within 30 days. On follow-up (median 380 days, range 135-582 days), five patients had another episode of lipofilling. Four patients underwent biopsy of a new lesion, all of which were benign. Disease-free survival was 100%. Conclusion: Early experience with immediate AFG suggests that it is feasible and safe in the short term. Long-term follow-up will evaluate patient satisfaction, cosmesis and further oncologic outcomes.