Greek women diagnosed with breast cancer reported on their coping efforts and levels of distress the day before surgery, 3 days after surgery, and 3 months later. Acceptance and humor were negatively related to distress at all three time points, whereas denial and emotional expression were positively related to distress post-surgery and 3 months later. The relationship between patterns of coping and distress was also examined. Specifically, participants who used emotion-focused engagement coping at pre-surgery, that is, acceptance or emotional expression combined with social support, experienced less distress 3 months later than participants who did not use any emotion-focused engagement coping. Finally, flexibility, defined as the use of multiple coping strategies, was found to negatively predict distress. The results indicate that pre-surgery use of emotion-focused engagement coping can be adaptive and that the adaptiveness of each strategy may vary as the stressor evolves.