Objective To investigate the risk factors of axillary non-sentinel lymph node metastasis by analyzing clinical data and pathological characteristics of early breast cancer patients with positive sentinel lymph node. Methods Clinical and pathological data about early breast cancer patients who underwent axillary lymph node dissection (ALND) with positive result of sentinel lymph node biopsy (SLNB) in Jinzhou Medical University First Affiliated Hospital and Anshan Central Hospital from July 2017 to July 2019 were retrospectively analyzed to explore the risk factors for axillary non-sentinel lymph node metastasis in early breast cancer patients with positive sentinel lymph node. Results There were statistical significance in differences between the two groups in tumor diameter, histological grade, vessel carcinoma embolus, molecular classification, and number of positive sentinel lymph node (P < 0.05). With multivariate analysis revealed that the tumor diameter (O^R = 1.784, 95% CI: 1.091, 2.916), vessel carcinoma embolus (O^R = 0.301, 95% CI: 0.113, 0.804), and number of positive sentinel lymph node (≥ 3 VS 1, O^R = 4.977, 95% CI: 1.114, 22.239) were independent risk factors for axillary non-sentinel lymph node metastasis. The risk of axillary non SLN metastasis in patients with more than 3 SLNs was 4.977 times higher than that in patients with 1 SLN. Conclusion For patients with early breast cancer patients with positive sentinel lymph nodes, the smaller of the tumor diameter, no vessel carcinoma embolus, the less of the number of positive sentinel lymph nodes, the lower possibility of axillary non-sentinel lymph node metastasis, there is guiding significance to avoid ALND.