This study examined associations between optimism, social support, and distress as they relate to psychosexual well-being among 136 women with Stage 0, I, and II breast cancer. Women were assessed immediately post-surgery and 3, 6, and 12 months post-surgery. Results support two cross-sectional mediation models. The first model indicates that patients who are more optimistic experience greater psychosexual well-being (i.e., feel more feminine, attractive, and sexually desirable) partly because they perceive themselves as having more social support available. The second model indicates that patients who are more optimistic experience greater psychosexual well-being partly because they experience less emotional distress related to the disease. When the two models were tested simultaneously, distress no longer contributed uniquely to the model at any time point except for 12 months follow-up.