<p>The management of the axilla in early breast cancer has evolved considerably, with sentinel lymph node biopsy (SLNB) now preferred for clinically node-negative (cN0) patients. Landmark trials such as ACOSOG Z0011 have advocated for the selective omission of axillary lymph node dissection (ALND) in certain cases, but real-world practice patterns, especially in India, remain under-reported. An online cross-sectional survey was conducted among breast surgeons in India to evaluate their practices in axillary management, familiarity with key clinical trials, and factors influencing clinical decisions. A total of 121 breast surgeons participated. While 97.5% were familiar with the ACOSOG Z0011 trial, only 52.9% had altered their practice based on its recommendations. Methylene blue dye alone was the most common SLNB technique (40.5%). Selective Level III dissection was performed by 91.7% of respondents. However, 71.9% still performed completion ALND for patients with 1–2 macrometastatic sentinel nodes. Despite high awareness of international evidence, significant variation persists in axillary management practices among Indian breast surgeons. There is a need for improved guideline dissemination, multidisciplinary decision-making, and resource optimization to achieve uniform, evidence-based care.</p>