This study examines the relationships among family resilience, functional exercise adherence, and symptom burden in postoperative breast cancer patients. In this cross-sectional study, participants consisted of 192 women with breast cancer who had undergone breast cancer surgery in two hospitals in Shandong Province, China. Family resilience, functional exercise adherence, and symptom burden were measured using the 32-item shortened Chinese version of the Family Resilience Assessment Scale (FRAS-C), Postoperative Functional Exercise Compliance Scale for Breast Cancer Patients, and the Chinese version of the M. D. Anderson Symptom Inventory (MDASI-C), respectively. Structural equation modeling was conducted to examine the path relationships among family resilience, functional exercise adherence, and symptom burden. Family resilience and its subscales were significantly negatively correlated with symptom burden (r ​= ​−0.17 to −0.14, P ​< ​0.05), whereas positively correlated with functional exercise adherence (r ​= ​0.64 to 0.69, P ​< ​0.01). Functional exercise adherence was significantly positively correlated with symptom burden (r ​= ​−0.32 to −0.35, P ​< ​0.01). Family resilience indirectly affected symptom burden through functional exercise adherence (β ​= ​−0.319, 95% CI: −0.491, −0.169). Family resilience, as a positive psychological factor, could indirectly impact postoperative breast cancer patients' physical function. Specifically, family resilience can alleviate the patients’ symptom burden by strengthening their functional exercise adherence. In addition to improving functional exercise adherence, nurses can also improve family resilience when helping to alleviate the symptom burden of postoperative breast cancer patients. Family resilience-based interventions could be implemented to alleviate the symptom burden among such patients.