Axillary Lymph Node Dissection (ALND) is considered the standard management of axilla in invasive breast cancer. Not only does it provide good local control but also provides pathological information about involvement of the axillary nodes which is essential for adjuvant treatment. However, the complications of ALND like lymphedema and restricted shoulder mobility led to replacement of ALND by SLNB in clinical node negative breast cancer. In those patients who are SLNB positive, Axillary radiotherapy is now an attractive option both in terms of Overall Survival (OS) and Disease Free Survival (DFS). The other features like axillary recurrence, local recurrence and distant recurrence have been seen to be similar both in ALND as well as ART in various studies. The earliest study which compared ALND versus ART directly was a phase III RCT NSABP B04. Long term follow up after 25 years showed no difference in DFS and OS. The contribution of axillary radiation on reducing the local recurrence rates was easily observed in the NSABP B04 in which there was no systemic therapy effect. Veronesi et al observed low axillary recurrence in cN0 patients who received who received wide local excision and radiotherapy. Frank J. et al also showed that in cN0 patients who were treated with breast conservation and radiotherapy, axillary recurrence rate was significantly low. These studies suggest that axillary radiation is a safe choice in patients who are clinically node negative. Besides, ALND leads to harmful complications like lymphedema and shoulder mobility restriction. The more recent AMAROS Trial also confirms that the type of axillary management (ALND versus ART) in patients with positive sentinel node does not have an effect on survival. Besides, axillary radiotherapy is associated with significantly less morbidity. Therefore, Axillary Radiotherapy is a valid treatment option with less morbidity than axillary lymph node dissection in cN0 but pN+ patients. However, patients with cN+, a multimodality approach including surgery followed by postoperative radiation provides the best local control and survival rates.