Contralateral axillary lymph node metastasis is a rare entity in breast cancer and is currently classified as a distant metastasis; however, recent studies have proposed aggressive curative treatment since this entity may manifest as a locoregional disease. Herein, we report a rare case of contralateral axillary lymph node metastasis that presented with imaging findings 22 months after the initial breast cancer diagnosis in a 67-year-old female. The patient underwent lymph node dissection of the axilla with adjuvant chemotherapy and radiotherapy. A follow-up examination 6 months after surgery showed no evidence of tumor recurrence or metastasis.