In patients with invasive breast cancer presenting with node positive disease, neoadjuvant chemotherapy is often recommended and can result in surgical downstaging in a significant proportion of cases. Management of the axilla in this setting has evolved. For those found to have a nodal pathologic complete response (ypN0), an axillary lymph node dissection (ALND) can potentially be avoided. Astrid Botty van den Bruele, MD, FACS, and Giacomo Montagna, MD, MPH, discuss the newly presented OPBC-04/EUBREAST-06 study, which supports omission of ALND in this population. The axillary staging techniques (SLNB vs TAD) are also addressed.