The big question for a lot of people embarking on breast cancer chemotherapy is “will my hair fall out?”. And (depending upon your chemo regime) the answer is often “probably”. Hair loss can be the most distressing thing for some people going through breast cancer. It just adds to the general crappiness that is breast cancer. Not only do we have to deal with all the emotional stress and worry that cancer brings; endure the physical trauma of chemotherapy and radiotherapy; now you are telling me that I have to do all of this with a bald head, no eyelashes and no eyebrows?
Although it may seem impossible, do try to come to terms with the fact that your hair will fall out. There are lots of ways to look good during treatment despite the hair loss. And remember that it will grow back.
Here are our top ten things to know about hair loss, followed by a list of link to some very helpful information about hair loss, wigs and cold capping. We’ve put this together from our perspective as patients and we encourage you to talk to your medical team about your personal situation.
The timing of the hair falling out depends upon the chemo drugs you are having. Your hair falls out by thinning first. You notice more than usual in your brush or on the floor of the shower. Quite soon after that, it starts to come out even when you just run your fingers through your hair – it comes out in handfuls. This is the most distressing part. And it is not just the hair on your head which falls out. It is all over your body. Yes, everywhere.
As soon as your hair starts to fall out is the time to make your decision – leave it to fall out, cut it shorter or shave it? You can leave it to fall out but you risk having bald patches showing up. You can cut it short which will temporarily camouflage the thinning hair. Or you can bite the bullet and get it shaved. There are salons which provide very kind, discreet services for people going through chemo: they may have a private area where you can go to have your head shaved (phone up your local salons to ask if they’d do this for you). If you do this, remember to take a hat or scarf with you for when you go home. Some people shave their hair off with friends and family at home. Or they do it themselves alone. If you do it yourself be very careful you don’t cut yourself because you don’t want to get an infection (remember your low immunity).
When your hair falls out your scalp can feel tingly and itchy. There are waves of this itchiness. All you want to do it rub and scratch your head. And as you rub and scratch your head, more hair falls out. And even after having your head shaved (if you chose that route) you will have some stubble on your head which will fall out, and as it does you will still get these irritating waves of itchy, tingly, prickly, tickly, crawling ants over your scalp. To help with this:
Special hair care is necessary in the days before your hair falls out, during the thinning stage, and throughout treatment if you are using the cold cap. Advice includes:
Chemotherapy-induced hair loss is widely recognised as the most feared side effect associated with cancer treatment. It is often the first question that people ask when they learn they will require chemotherapy, “Will I lose my hair?” Many patients rank hair loss as the most feared and traumatic side effect of their cancer treatment, it can lead to social isolation and the psychological effect is high often having a dramatic impact on self-esteem.
Scalp Cooling Technology, also known as the Cold Cap, can alleviate the damage caused to the hair follicles by chemotherapy by reducing the temperature of the scalp by a few degrees before, during, and after chemotherapy treatment. This cooling causes blood vessel vasoconstriction in the scalp, which reduces blood flow and, therefore, reduces the number of chemotherapy agents that reach the hair follicles. The treatment is safe and relatively easy to tolerate. The most common side effect is a minor headache caused by the cooling. Research shows that scalp cooling does not affect cancer treatment and for patients, this means the opportunity to regain some control, maintain their privacy, and encourage a positive attitude toward their illness and treatment.
Scalp cooling isn’t for everyone and there are different results with different drugs and dosage. Each person will also respond differently to scalp cooling – some will retain a vast amount of hair, for others, even on the same drug regime, they may see poorer results. However, the thing that encourages many people to try scalp cooling is the fact that it encourages faster, healthier and stronger regrowth than would occur without scalp cooling. So even if less hair is retained than you would have ideally liked, you are looking after your future hair regrowth by scalp cooling.
At the moment there are no guarantees that you will be able to retain your hair with scalp cooling, but Paxman’s current data shows (across all drug regimens) that you have a 50% chance of keeping 50% of your hair, and as much as 80% chance with some drugs. To be completely blunt, if there is 20% or even less of your hair left at the end of chemo treatment, scalp cooling has worked, as without it there would not be a single hair left on your head within a month of your first treatment. You can get an indication of your potential hair retention based on data from over 7000 patients with the decision making guide on the Paxman patient support website.
The Paxman Scalp Cooling System is a self-contained, mobile, and electrically powered cooling unit, which circulates liquid coolant at low pressure through a special cooling cap worn by the patient. The circulation of the refrigerated coolant through the cap extracts heat from the patient’s scalp maintaining temperature.
Before your nurse fits your scalp cooling cap you prepare your hair accordingly to your specific hair type. Scalp cooling will add extra time on to treatment day. Everyone needs a 30-45minute pre-infusion cooling time and the cooling also continues throughout the infusion time of the chemo drugs, and for an additional post-infusion cooling time dependent on the drugs you are receiving.
Thanks to Claire Paxman of Paxman Cold Capping for contributing this section of the page.
Before you start your chemo treatment have a think about whether you are going to get a wig. You can get fantastic wigs which are so realistic and close to your original hair style that you don’t look as if you are wearing a wig. Or you can have some fun and get some fun wigs and wigs with the hair style you’ve always wanted. Take a look at the My New Hair website which is a super website all about wigs. They have a really helpful patient booklet giving loads of information about hair loss, different types of wigs, choosing and caring for a wig, hair re-growth and aftercare. It lists nationwide salons who provide wig services.
Wigs vary in cost from around £30 for a synthetic wig, up to around £600 for a real hair wig. Some health insurance companies pay for, or contribute towards, the cost of a wig so check with them. Or you may be entitled to an NHS wig or a NHS wig voucher. Research your options. Wigbank is an online shop selling pre-loved wigs (washed, conditioned and disinfected) and can be a more reasonable cost option. Macmillan has lots of helpful information about getting a wig including how to apply for a free NHS wig.
If you want your wig to look like your original hair then the salon can often find a good match and then style it. They can really work wonders. A big tip is to take a few photos of your hair before it begins to fall out so that the salon catch match a wig to your natural style and colour. Take a friend. A friend sees your hair from all angles and can give honest advice about how much a wig looks like your original hair. Do get a wig liner made from a soft fabric because the underside of the wig can be uncomfortable.
THINGS TO BEAR IN MIND ABOUT GETTING A WIG:
Scarves. You don’t need to buy special scarves to wear on your head. You may have some already that you can use. Tying scarves on your head can be tricky (so they don’t come unravelled in public) but there are a lot of online tutorials to help you. Pinterest and YouTube are good places to start, and there are more listed in the helpful link section below.
Hats. There are also a lot of places which sell hats which look like scarves but which are already tied. If you choose to buy some of these then looking online is a minefield. There is a lot to choose from online. The best thing is to set aside an afternoon, pop the kettle on, make a cup of tea and search online for what you like.
Whether you plan to wear scarves or hats or both, make sure you have a couple so that you always have one to wear if one is in the wash. And look for natural, soft fabrics because your scalp will be sensitive.
Night caps. Definitely get a couple of night caps. Having a bald head at night is chilly. Plus your scalp can feel very sensitive against a pillow.
If you google “chemo hair loss henna tattoos” and look at the images you will see some absolutely beautiful bald heads.
For some people all their eyebrow hairs fall out and all their eye lashes fall out. For others they may just thin and some people don’t lose any.
Yes your hair will grow back.
1, When? It depends on which chemo drugs you are on. And everyone’s hair regrowth is different. For some people it can grow back before chemo ends. For others it can start a few weeks after the end of chemo.
2. How? To start with the hair that comes through is a soft fuzzy hair, a bit like a baby’s new hair. Then after a few weeks/month the real hair comes through. It doesn’t grow evenly over your head and can be patchy to start with. And when your hair starts to properly grow, it may be different to your previous hair. You may have curly hair when you used to have straight hair. It may be a different colour. It may be thinner or coarser. Everyone is different.
3. Hair care. Look after your new hair carefully. Use gentle shampoos and conditioners (try ph neutral, paraben free or organic).
4. Assistance. There are plenty of shampoos on the market which claim to help your hair grow back. Whether these actually work or not is debatable and up to you to decide if you want to try them.
5 Wigbank. If you had a wig why not consider donating it to this charity Wigbank which washes and disinfects pre-loved wigs for other people to buy at an affordable price.
Penny Brohn has a helpful article on their site about hair loss: Chemotherapy Hair Loss – What You Need To Know
Headwrappers is a charity providing free support to anyone suffering hair loss as a result of cancer treatment. They go around the country visiting cancer charities and putting on sessions for support groups. However, with the lockdown, they currently put on a regular online session for people to get together and chat about hairloss: “Tea, Topknots & Turbans”. It’s the first and third Thursdays of each month. And they have tied up with a number of charities to provide online support groups each month where they give advice on headscarf tying, practical scalp care, hair loss concerns and so on. These are done with places including Future Dreams, Maggies, and Trekstock.
Wigs for Heroes is a small charity providing support for people who lose their hair. They put on a lot of support via Instagram such a video tutorials, tips, advice on caring for wigs and weekly “online coffee mornings”, plus more.
The major charities all provide support for hair loss:
Look around for a local support group or salon that provides support for women suffering hair loss.
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Reviewed February 2023
Unless otherwise stated, the information and content provided on this page has been written from a patient’s perspective then reviewed by a breast care nurse and it is intended for information and educational purposes only. It is not intended to substitute for professional medical advice. Please contact your medical team for advice on anything covered in this article and/or in relation to your personal situation.
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Sylvie and Danielle began Future Dreams with just £100 in 2008. They believed nobody should face breast cancer alone. Their legacy lives on in Future Dreams House. We couldn’t continue to fund support services for those touched by breast cancer, raise awareness of breast cancer and promote early diagnosis and advance research into secondary breast cancer without your help. Please consider partnering with us or making a donation.