Introduction
Hair loss is a common side effect of breast cancer treatment and can be deeply distressing. This experience often impacts self-esteem and body image. The booklet helps individuals prepare for, manage, and recover from hair loss with practical and emotional support, including information on scalp care, wigs, headwear, and hair regrowth.

Emotional Impact

Hair loss can significantly affect confidence and identity. People may feel vulnerable, exposed, or labelled as “a cancer patient.” Emotional responses vary—some find hair loss to be one of the hardest parts of treatment, while others adjust more easily. In some cultures and religions, hair has particular significance, making the experience more complex.

Talking to Others

Telling people about hair loss is personal—some share only with close friends and family, while others are open with everyone. Reactions may vary and can be difficult to navigate. Children may need reassurance and preparation; they often adjust better than expected when involved early and honestly.

Treatments That Cause Hair Loss

1. Chemotherapy
The most common cause of hair loss. Some drugs cause thinning, others complete loss. Hair loss typically starts 2–3 weeks after the first cycle and may include body hair. Regrowth usually begins 3–6 months after treatment ends.

2. Targeted (Biological) Therapies
Drugs like trastuzumab emtansine and ribociclib can cause thinning or loss, especially when combined with chemotherapy. For those with secondary breast cancer, long-term use can prolong hair loss.

3. Immunotherapy
Rarely causes hair loss, but some combinations (like atezolizumab with nab-paclitaxel) can.

4. Radiotherapy
Only causes hair loss in the treated area (e.g., head, armpit, or chest). Hair may grow back patchy or not at all, depending on the dose.

5. Hormone Therapy
Medications like tamoxifen and letrozole may cause mild but prolonged hair thinning.

Preparing for Hair Loss

Planning ahead can help reduce anxiety. Options include:

• Cutting or shaving your hair in advance
• Choosing and getting fitted for a wig early
• Learning about headwear and makeup
• Consulting with hair loss support services like Cancer Hair Care

Preventing Hair Loss: Scalp Cooling

Scalp cooling reduces blood flow to hair follicles during chemotherapy, helping some retain hair. This can be done using a cold cap or machine-based system. It’s not effective for everyone and may be less so for Afro hair. Side effects include headaches and discomfort, which typically ease after the first 10–15 minutes. Always consult your team to determine if it’s suitable for you.

Hair Care During Treatment

Even if hair isn’t lost, treatments can make it dry or brittle. Tips include:

• Using mild shampoo
• Washing less frequently
• Avoiding heat styling and tight hairstyles
• Moisturizing the scalp, especially for Afro-Caribbean hair

Coping with Hair Loss

Hair typically starts to fall out gradually. The scalp may become tender. Gentle scalp care, using non-perfumed moisturizers, and protecting from sun and cold are essential. Many people wear wigs, scarves, or hats—others choose not to cover their heads at all. Confidence comes from choosing what feels right for you.

Wigs

Modern wigs are natural-looking and comfortable, made from synthetic or real hair. NHS wigs are free in Scotland, Wales, and Northern Ireland, but may require a fee in England unless you’re eligible for financial support. Wig fitting services are often available at hospitals or specialist shops. Some people choose to get their wig professionally styled to resemble their natural look. Wigs can also be donated when no longer needed.

Headwear Options

Alternatives to wigs include:

• Scarves and Bandanas – Stylish, breathable, and customizable. Tutorials are available for tying techniques.
• Hats and Turbans – Comfortable and easy to wear.
• Fringes and Hairpieces – Attach under hats for a more natural look.
• Headbands – Useful for covering thinning patches.

Accessories like jewelry and bright makeup can help redirect attention and boost confidence.

Body Hair Loss

Chemotherapy may cause loss of eyelashes, eyebrows, nasal, pubic, and body hair. While some find this inconvenient, others appreciate the reduced grooming. Products and techniques for makeup, false lashes, or stick-on eyebrows can help maintain appearance.

Eyelash and Eyebrow Tips:

• Use eyeliner to mimic lashes
• Use pencils or powders to recreate brows
• Explore semi-permanent makeup (microblading or micropigmentation) for long-term solutions

Hair Regrowth

Hair usually starts regrowing a few months after treatment. It may come back with changes in texture, color, or curl pattern. Regrowth can be patchy and take up to a year to fully return. Conditioner, gentle care, and tools like thickening fibers can help during this transition.

Supplements and products like minoxidil or bimatoprost (for lashes) may help, but consult your doctor before use. Wait at least six months before applying permanent hair dye. Use natural or semi-permanent products initially.

Permanent Hair Loss or Thinning

While rare, long-term hair loss can occur, especially with taxane chemotherapy drugs. Radiotherapy and extended hormone therapy may also cause lasting thinning. Consulting a dermatologist or trichologist is advised for persistent hair loss. Cosmetic solutions include:

• Micropigmentation
• Hair concealers
• Hair replacement systems (usually private and costly)

Support and Resources

Hair loss is a personal journey. Emotional and peer support can ease the burden. Services include:

• Breast Cancer Now Helpline: 0808 800 6000
• Someone Like Me: Speak with others who’ve been through similar experiences
• Look Good Feel Better: Offers skincare, makeup, and headwear workshops
• Cancer Hair Care: Offers practical support, tutorials, and product guidance
• Alopecia UK, My New Hair, HeadWrappers: Specialized hair loss resources

Hair loss from breast cancer treatment is difficult, but with information, preparation, and support, many people find ways to adapt and feel confident again.