Background: Evaluation of surgical feasibility, aesthetic outcomes and 6-m postoperative (PO) effect of immediate breast reconstruction (IBR) using autologous fibrofatty flaps after localized small breast mass excision.Methods: Total 29 women had duct carcinoma of <50 mm in diameter with N1-3 regional lymphadenopathy were studied. Through diamond-shape incision, breast gland was removed with 1 cm circumferential free safety margin, then the medial and lateral fibrofatty flaps were undermined and approximated for IBR. Breast measurements; the nipple-to-suprasternal notch distance and the nipple-to-nipple distance were determined preoperatively and 6-m PO. Quality of life (QoL) evaluation was performed preoperatively and 6-m PO using the short-form-36 (SF-36), the multidimensional body self-relations questionnaire appearance assessment and the European organization for research and treatment of cancer breast cancer-specific QoL questionnaire scores in breast cancer. Results: Mean operative time was 94.5±15.4 min; mean intraoperative blood loss was 170.1±34.9 ml and 25 patients had returned home on the same operative day. Two patients had PO wound seroma and one patient had wound hematoma, but were resolved spontaneously. PO breast measurements showed non-significant differences in comparison to preoperative measurements of the same breast, and to measurements of the contralateral breast. PO evaluation of QoL showed significantly improved PO scoring in line with improved body image and future perspectives, and sexual scores in comparison to preoperative scorings. Conclusions: The applied procedure of localized excision of BC mass of<50 mm with IBR using the breast remnant fibrofatty flaps provided acceptable surgical and esthetical outcomes and allowed improvement of patients’ QoL.