Background <p>Risk factors associated with developing lymphedema following axillary lymph node dissection (ALND) are well-described in the literature. However, lymphedema diagnosis criteria is arbitrary and can vary between studies. This study instead aims to identify protective factors associated with normal lymphatic function after ALND for treatment of breast cancer. </p> Methods <p>This was a prospective study of women treated with unilateral ALND for breast cancer between 2020 and 2023. Patients with normal lymphatic function were defined as meeting all of four criteria: &lt;10% arm volume change from baseline, &lt;10 bioimpedance change from baseline, no compression use, and Stage 0 on ICG lymphography at one year follow-up. All other patients were classified as having abnormal lymphatic function. Univariable and multivariable logistic regression were used to examine variables possibly associated with normal lymphatic function.</p> Results <p>Of 150 patients with 1-year follow-up, 39 patients (26%) had normal lymphatic function and 111 patients (74%) had abnormal lymphatic function. On multivariable analysis, immediate lymphatic reconstruction (ILR) and younger age were significantly associated with normal lymphatic function. The odds of normal lymphatic function in patients who had ILR were 2.79 times higher than that of patients who did not undergo ILR (odds ratio [OR] = 2.79, 95% confidence interval [CI] = 1.23–6.69, <i>p</i> = 0.017). Meanwhile, increased age was associated with decreased odds of normal lymphatic function (OR = 0.93, 95% CI = 0.89–0.97, <i>p</i> = 0.001).</p> Conclusions <p>Immediate lymphatic reconstruction and younger age are significantly associated with normal lymphatic function 1 year after ALND. These findings suggest that undergoing ILR may be protective against developing breast cancer-related lymphedema.</p>