Purpose Lymphoedema is a common complication after axillary dissection in breast cancer, affecting up to 50% of patients. It significantly impacts quality of life, potentially leading to complications such as infection, fibrosis, and limb dysfunction. This study aims to present a novel method for lymphoedema prevention by preserving lymphatic drainage pathways using lymphatic-venous bypass (LVB). Methodology We describe a refined approach using indocyanine green (ICG)-guided axillary reverse mapping with LVB. This method is offered to patients with locally advanced breast cancer and significant axillary nodal burden. ICG is injected at three sites near the cubital fossa pre-dissection. The dye highlights sentinel lymph nodes, which are detected using the SPY imaging system. Following dissection, the lateral sentinel node is located, and the anterior vein is approximated to the ICG-labelled lymph node with a 5/0 Prolene suture, creating a tension-free lymphatic-venous bypass without microsurgery. Results This technique avoids the need for complex procedures and does not increase operative time. Early post-operative outcomes show no cases of lymphoedema among treated patients. Conclusion The ICG-assisted axillary reverse mapping with LVB is a minimally invasive, efficient method for preserving lymphatic drainage in high-risk axillary dissection. Prospective, randomised trials are required to further validate the long-term efficacy of this approach.