Marital satisfaction is an important indicator of adaptation in patients with cancer; however, its relationship to medium-to-long-term health-related outcomes is less well understood. Married women (N = 152) at least six months post-mastectomy were surveyed to determine whether marital satisfaction predicted non-weight-related body image distress (BID), pain impact, and mood, or whether the directionality of this association operated in reverse. Structural equation modeling indicated that the model predicting medium-to-long-term health-related outcomes from satisfaction better fit the data and that time influences mood.