Background: We investigated the mediating role of personality compatibility, couple communication, and sexual life in the psychological resilience and marital satisfaction of women with breast cancer. Methods: This is a cross-sectional survey. From March 2022 to June 2022, we enrolled 212 women with breast cancer from a tertiary tumor hospital in Xinjiang, China using a convenient sampling method. The basic information of patients was collected. The marriage quality and psychological resilience were assessed with the Enrich Marital Inventory and Connor-Davidson resilience scale, respectively. Counting data are expressed using the number and frequency while measuring data are presented using mean \pm standard deviation. Statistical tests included one-way ANOVA and t-test. Pearson correlation was performed. The mediating effects were analyzed using the Baron and Kenny stepwise method. Results: The mean marriage quality score of women with breast cancer in marital satisfaction was 31.38 \pm 8.36, in couple communication was 31.28 \pm 7.15, in sexual life was 31.16 \pm 7.76, in personality compatibility was 29.61 \pm 7.32, and in psychological resilience was 53.60 \pm 12.05, all of which were lower than the corresponding female norms. Correlation analysis showed that the three factors of psychological resilience (tenacity, strength, and optimism) of women with breast cancer were positively correlated with marital quality (marital satisfaction, personality compatibility, couple communication, and sexual life). The mediating effects of personality compatibility, couple communication, and sexual life on psychological resilience and marital satisfaction of women with breast cancer were significant (p 0.001). Their effect values accounted for 48.6%, 63.1%, and 64.4% of the total effects, respectively. Conclusions: The level of psychological resilience and marital satisfaction of women with breast cancer is low. Psychological resilience can not only directly affect the marital satisfaction of women with breast cancer, but also indirectly affect marital quality through personality compatibility, couple communication, and sexual life. Medical workers should pay attention to the psychological status and marital satisfaction of women with breast cancer.