〔Abstract〕 Objective To analyze risk factors for non-sentinel lymph node (NSLN) metastasis in breast cancer patients with sentinel lymph node (SLN). Methods Clinical patients with early breast cancer who underwent surgery for positive SLN in Fujian Provincial Hospital from January 2013 to January 2020 were collected and analyzed, and the related influencing factors of NSLN metastasis were analyzed. Results There were 167 cases of NSLN metastasis in 443 positive SLN breast cancer patients. In a single factor analysis, there were statistically significant differences in primary tumor size, number of positive SLN, number of negative SLN, number of SLN metastasis, positive rate of SLN metastasis, and type of SLN metastasis between positive and negative patients with NSLN metastasis (P < 0.001). Multivariate logistic regression analysis showed that T2, positive number of SLN ≥ 3, positive rate of SLN metastasis ≥ 50 % and SLN macro metastasis were independent risk factors for NSLN metastasis, the area under curve (AUC) of independent risk factors combined predicted NSLN metastasis was 0.747 > 0.7. Conclusion In clinical early breast cancer patients with SLN positive, the primary tumor size T2, the number of SLN positive ≥ 3, the positive rate of SLN metastasis ≥ 50 % and SLN macro metastasis are the risk factors for the occurrence of NSLN metastasis. The combined diagnosis of the above factors can better predict the metastasis of NSLN, guide surgical procedures and avoid over-treatment.