Abstract: Background: Axillary lymph node dissection (ALND) is associated with many complications as lymphedema. The oncological safety of preserving the upper limb lymphatic is still unclear. The aim of the current study is to determine the oncological safety of sparing upper limb lymphatic in clinically negative and Sentinel lymph node biopsy (SLNB) positive axilla. Patients and Methods: Ninety-eight early breast cancer patients with clinically negative axilla were conducted in this study during the period between March 2013 and October 2014. Positive SLNB patients were randomized into two groups, group I for standard ALND and group II for conservative ALND. Conservative ALND group patients underwent Axillary revers mapping (ARM) for identification of upper limb lymphatic and sparing these lymph nodes during ALND. All patients were followed up till April 2017 with follow up period ranged from 30 – 49 month (mean follow up period was 39 month). Results: lymphedema occurred in 10(25%) patients in group I, while no lymphedema in group II. No local recurrence occurred in both groups during the period of follow up. paresthesia ,pain and loss of shoulder mobility were more in group I. Conclusion: Conservative ALND is oncologically safe as standard ALND in pathologically positive axilla and less in complications regarding lymphedema, parasthesia, pain and loss of shoulder mobility. [Mohamed I Abdelhamid, Wael Al-Shelfa, Hassan Ashour, Salah AbdElaal, Mansour M Morsy, Osama abd Elaziz, Mohammed Alkilany, Ahmed R Elsayed, Alaa khalil Oncological safety of conservative axillary lymph