This retrospective pilot study examined the relationship between psychological status at the time of breast cancer diagnosis and ratings of cosmetic outcome later. Sixty-three patients completed measures of depression, anxiety, and quality of life at the time of diagnosis. Following lumpectomy and radiation therapy, these patients and their radiation oncologists completed ratings of the quality of the cosmetic outcome (Cosmesis). The results indicated that both psychological distress and quality of life were related to patients' ratings of Cosmesis, while only patients' quality of life was related to physicians' ratings of Cosmesis. We conclude that Cosmesis is a multifaceted construct that incorporates both physical and psychological factors.