OBJECTIVES: The purpose of this study is to evaluate the effects of attachment security, social support and health-related burden in the prediction of psychological distress and the mediation effects of social support and health-related burden in relationship between attachment security and psychological distress. METHODS: Finally, 161 patients were included for the analysis. Chi-square test and independent samples t-test were used for comparing differences between depressive/anxious group and non-depressive/non-anxious group. For evaluating the relationship among attachment security, social support, psychological distress and health-related burden, structural equation modeling analysis were performed. RESULTS: 40.7% and 32.0% of the patients have significant depressive symptoms and anxiety symptoms, respectively. In the analysis for testing the differences between groups who have psychological distress and who have not, there were no significant differences of sociodemographic factors and medical characteristics between groups, except for association between depressive symptoms and type of surgery (p = 0.01). Contrary to sociodemographic and medical characteristics, there were significant differences of health-related burden and two coping resources (attachment security and social support) between groups (all p < 0.01), except for the support from medical team in between anxious group and non-anxious group (p = 0.20). In the structural equation model analysis (Model fit : chi-square/df ratio = 0.8, root mean square error of approximation = 0.000, comparative fit index = 1.000, non-normed fit index =0.991), attachment security and social support emerged as an important predictor of psychopathology. CONCLUSIONS: Attachment security and social support are important factors affecting the psychological distress. We suggest that individual attachment style and the social support state must be considered to approach the newly diagnosed breast cancer patients with psychological distress.