Axillary lymph node dissection (ALND) is frequently used in breast cancer surgery as the gold standard for assessing the status of axillary lymph nodes. However, with the development of medical techniques, more attention is paid to the patient's quality of life on the premise of ensuring survival and minimizing recurrence. The use of ALND in breast cancer patients is gradually declining due to its side effects such as arm lymphedema and shoulder dysfunction. Moreover, it is increasingly being replaced by sentinel lymph node biopsy (SLNB), which has the advantages of the less invasiveness and maintaining better patients' quality of life and is also a standard procedure to manage the axillary lymph nodes in early invasive breast cancer. Neoadjuvant chemotherapy (NAC), as an important part of systemic treatment of breast cancer, can not only shrink the tumor and increase the chance of radical surgery, but also increase the rate of breast conservation, and thereby bring benefits to more patients. However, the feasibility of performing SLNB after NAC is controversial, because the low detection rate and high false negative rate (FNR) of SLNB after NAC resulting from the influence of NAC exerted on the lymphatic vessels. It is an urgent clinical problem that how to help more breast cancer patients who meet eligibility criteria to avoid ALND to obtain more treatment benefits. Currently, many new technical approaches have been attempted to improve the detection rate and reduce the FNR of SLNB after NAC for breast cancer. Compared with using a single tracer, lymph node tracing in breast cancer using conventional dual tracer composed of radioisotope and blue dye, or combined with other new tracers such as carbon nanoparticle suspension, indocyanine green fluorescence, microbubble ultrasonography, superparamagnetic iron oxide, or using nanoparticle-assisted axillary staging, can significantly improve the detection rate of SLNB. Several large prospective trials have demonstrated that guarantee of removing ≥3 sentinel lymph nodes can dramatically reduce the FNR of SLNB; targeted ALND, a complement to SLNB, can facilitate a precise lymph node dissection by marking and locating the positive lymph nodes before operation, and its accuracy can be further enhanced by localization of radar reflectors, carbon tattoos, radioactive particles, magnetic particles, and intraoperative ultrasound. In addition, some recent studies have proposed to the combine with imaging examinations such as axillary ultrasound and CT lymphography, which can display the anatomical structure of lymph nodes and the surrounding lymphatic vessels clearly, to increase the certainty of clinicians, further improve the detection rate and reduce the FNR, but it has not been confirmed by data from large clinical trials yet. Herein, the authors systematically summarize the current research progress related to analysis of sentinel lymph nodes after NAC, aiming to provide some ideas and directions. The issue of how to make a choice in clinical practice to benefit more patients still needs a large number of studies to identify in the future.