Fleabag said it best, of course. In series two, Phoebe Waller-Bridge’s character burst into a salon to demand compensation for her sister’s ‘pencil’ haircut. “Hair is everything,” she declared. “We wish it wasn’t, so we could think about something else occasionally, but it is. It’s the difference between a good day and a bad day.”
When I was diagnosed with breast cancer in January 2021, I had a sinking feeling that there would be many bad days ahead. I didn’t know much about chemotherapy, but the thing that everyone does know is that you lose your hair.
One of the nurses mentioned in passing that I could wear the ‘cold cap’ to reduce hair loss. I had never heard of it and it was never explained to me so, as with many steps along the way of cancer treatment, I had to do my own research. Now, having been through five months of chemotherapy, I feel like something of an expert.
Lauren Mahon tells GLAMOUR how she reconnected with her body following her breast cancer diagnosis.
Chemo medication kills cancer cells after identifying them because they multiply quickly. But anything that grows or renews involves multiplying cells, so that means nails and skin, as well as the inside of your mouth and your stomach – all of which take a hit during chemo. But the most visibly noticeable effect is on your hair.
The cold cap works by cooling your scalp to reduce blood flow to your head. It’s like a helmet, strapped on tightly before each chemo session, containing liquid coolant that flows through a tube at the back of your neck to a large machine.
Without the cold cap, I would have lost all my hair immediately.
It feels like wearing a hat of ice but, when I speak to Claire Paxman, of Paxman Scalp Cooling (the company that makes the vast majority of the cold cap machines in NHS hospitals) she’s keen to disabuse me of the idea that it literally froze my head.
“It's a common misconception, but we do not freeze your hair follicles,” she explains, warmly. “We're taking them to the optimum temperature of 18 to 22 degrees.” It feels so much colder than that, I shudder. “That's because the liquid coolant has to be sub zero to achieve the temperatures rapidly. But we've come a hell of a long way from the old type of cold caps, which were around -20 degrees.”
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Still, no one is going to tell you the experience is relaxing. It’s certainly uncomfortable, but I soon realised the first 20 minutes are the worst so, if you can distract yourself for that time (Netflix works well, I find), then it settles into a bearable numbness.
But does it work? I canvassed opinions before I started and some enthusiastically recommended it after retaining most of their hair, while others said it didn’t work for them, and advised me not to put myself through any additional discomfort during chemo.
This was by far the hardest point; not recognising myself in the mirror.
“Hair retention does differ depending on the type of chemotherapy and the dose,” explains Claire. She says the treatment I had (four fortnightly cycles of AC chemo, followed by 12 weekly doses of paclitaxel and carboplatin – a common combination for breast cancer) is some of the most hair-loss-causing types of chemo. “But across all the chemotherapy ranges, you've got a 50% chance of retaining 50% or more of your hair.”
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So did it work for me? For the first few weeks it seemed to. Without the cold cap, I would have lost all my hair immediately. Instead, while it was noticeably thinner, I didn’t have any bald patches until about two months into treatment. Yes, bald patches.
Alongside the bleak reality of sweeping clumps of my hair into the bin, by April I had long strands around the sides and back of my head, but the top was going completely bald. This was by far the hardest point; not recognising myself in the mirror. I learnt to tie a headscarf and pencil on non-existent eyebrows but, at home with no scarf or make-up, I looked like a clean-shaven Bill Bailey.
Fleabag was right: hair is everything.
During this time, one of the chemo nurses recommended I stop using the cold cap. She said the exposed scalp on top of my head could be damaged, actually inhibiting regrowth. Luckily, I insisted on continuing, brushing over my remaining hair to protect the bald bits. “The idea that it could damage hair follicles is another myth,” says Claire, explaining that you can protect any exposed scalp by either brushing over hair as I did, or wearing a paper theatre cap. And it’s worth persevering.
“By continuing to scalp cool, even if you feel it's not worked, you are protecting your follicles to the point that hair grows back thicker and faster within a 12 week period,” she says. Indeed, by the time chemo finished in June, I was reassured to see that my hair was already starting to grow back on top. Two months later, I ditched the headscarf in favour of hair bands and clips. By November, the shortest bits were long enough for my hairdresser to chop it into a crop.
There are proactive things that you can do to improve your chances of the cold cap working. “Getting the right fit is the most important thing,” says Claire. “If that cap is not in direct contact with any part of your scalp, it's not being sufficiently cooled.” A common problem is ‘tenting’, where the cap isn’t pressed firmly to the top of your head.
I wish I’d learnt more about it before starting chemo because, as Claire explains, doing your homework can make all the difference. “We want people to take a bit of ownership with it because the nurses – who are absolutely under the cosh – might not have spent that extra five minutes making sure that the cap is the right size.”
Would I do it again? If you’d have asked me two thirds of the way through chemo, I might not have had many nice things to say about the cold cap. Now, I’m glad I did it. My body has been through so much this year – chemo, radiotherapy and mastectomy surgery – that I would do anything to look and feel like my old self again.
Fleabag was right: hair is everything. And mine growing back is a symbol of healing from a traumatic year. That’s everything to me.
If you are concerned that you may have symptoms of breast cancer, it's recommended to book an appointment with your GP to discuss diagnosis and treatment. You can find your local GP here.
For more information about checking your breasts, click here.
© Condé Nast Britain 2021.