Contralateral axillary metastasis (CAM) is a rare entity normally treated as a systemic disease. Recent publications have proposed aggressive surgical treatment with benefits to the patients in terms of survival. We present a case of a 74-year-old patient with a history of unilateral breast cancer, recurrence on the ipsilateral breast and then development of a CAM. The patient was treated with aggressive surgical treatment, but she developed an early recurrence of the disease with distant metastasis. There is limited evidence of the correct management of CAM, although proposed to treat it as a loco regional disease, individualized and multidisciplinary management is the best option for these patients.