Friends Boutique
Frequently Asked Questions
This page contains a list of answers to common questions about the cosmetic side effects of cancer treatment.
Alocepia
- When will alopecia occur
- How much hair is lost?
- Why does hair fall out?
- Who can help me with hair loss?
- When does hair grow back?
Hair Alternatives
- What types of hair alternatives are available?
- What special care does a hair prosthesis require?
- Will the hair prosthesis be comfortable?
- What should I know about hair and scalp care during therapy?
- Will my insurance cover my hair prosthesis?
Breast Prostheses
- What is a breast prosthesis?
- Why would I need a breast prosthesis?
- What are the advantages of having a breast prosthesis?
- How soon after surgery can I be fitted for my breast prosthesis?
- What is a mastectomy bra?
- Will my insurance cover my breast prosthesis and prosthetic bras?
Lymphedema
- What is lymphedema?
- What Does the Friends Boutique carry for lymphedema?
- Will my insurance cover my lymphedema garment?
Cosmetic Advice
- How should I take care of my nails?
- What happens when eyebrows and eyelashes are lost?
- How should I take care of my skin?
Visiting the Boutique
- Do I need to make an appointment before coming into the Boutique?
- Do I need to bring a prescription to my appointment at the Boutique?
- What doesn't the Friends Boutique sell wigs, mastectomy bras and prostheses, and compression garments over the Internet?
When will alopecia occur?
The clinical term describing hair loss is Alopecia. Hair loss usually occurs two to three weeks after chemotherapy or radiation therapy begins. The rate at which one loses hair will vary, as each individual responds differently to treatment. Several days before hair loss occurs, your scalp may become very itchy and sensitive.
How much hair is lost?
Chemotherapy may affect all body hair. Since scalp hair is generally in an active growth phase, it is affected by chemotherapy more often than other body hair. Alopecia is usually temporary among patients receiving chemotherapy.
Radiation therapy affects hair in the area that is being irradiated. With radiation therapy, hair loss may or may not be permanent. The amount of hair loss can range from thinning to complete baldness. For patients treated with chemotherapy, the degree of hair loss is dependent on the drug and dosage used. The quantity of hair loss as a result of radiation therapy is dose and site-dependent.
Why does hair fall out?
Cancer cells divide and grow rapidly. Hair is also made up of fast growing cells. Radiation therapy and chemotherapy are designed to affect any cells that multiply quickly and cannot differentiate between cancer cells and hair cells. This causes the hair to fall out at the root.
Who can help me with hair loss?
Before hair loss occurs, see a professional who can assist you in selecting a wig that closely matches your hair style and color and who will show you other hair alternatives that are available. Early consultation can ease your mind before you begin your treatment. Have a friend or family member present to offer support and a second opinion.
When does hair grow back?
- Normally, hair does not grow back until you have completed your chemotherapy.
- Some people do experience hair growth before the therapy is completed.
- Radiation therapy may retard hair growth.
- Regrowth does not usually begin until several months after the radiation treatment is completed.
- It may take six months to one year for hair to regrow to prior length; hair generally grows about a quarter of an inch every four weeks once you have completed treatment.
- If you want to have your hair chemically curled, it is best to use a mild body wave. In order to prevent damage to the recovering hair shaft, wrap your hair loosely on the largest curling rod for a short amount of time.
- If you want to color your new hair, a safer, gentler way to do so is by using a semi-permanent color. Do not bleach hair to lighten.
What hair alternatives are available?
- A natural-looking hair replacement that will stay in place, is easy to care for, comfortable to wear, and reasonably priced.
- Wraps should be cotton, polyester, or rayon, not silk.
- Hair prostheses (wigs) create a more natural look.
- Hair prostheses can be made from synthetic hair, human hair, or a combination of the two.
- Any hair prosthesis should be fitted and shaped to suit each individual.
- Combinations of head wraps, hats, and scarves are available in many styles.
What special care does a hair prosthesis require?
Wig Care
- A hair prosthesis should be washed only when needed, or after about 20 wearings for synthetic made. Less is better. Human hairpieces usually need to be cared for every day.
- Soak the prosthesis in a mild, gentle shampoo for a few minutes using cool water and rinse thoroughly.
- Pat with a towel to remove excess moisture and shake the prosthesis vigorously. Hang over bathtub knob or bottle neck to dry, if you do not have a wig stand.
- Do not brush synthetic-made wigs while wet.
Styling
- Style after wig is thoroughly dry. Do not use a curling iron or hair dryer on synthetics or blends.
- Always use a vent brush or pick for curly styles and straight styles.
- Avoid using standard hair brushes because they can create excessive tension, over-stretching the hair and damaging it.
- Think "reverse" when brushing your wig. Start from the ends and work gradually toward the root area of the wig. When using a wire pick, also work the curls from ends to root area.
- Do not wear your hair prosthesis near extreme heat (cooking, baking, or when using a barbecue).
Will the hair prosthesis be comfortable?
- If fitted properly and securely, your wig will be comfortable.
- A cotton skull cap is recommended for under the wig to reduce any itching.
- Wigs that are too big can be altered and wigs that are too small can be stretched to fit your head.
Tips for securing wig:
- adjust tabs, pull in to tighten, let out to loosen
- hairpiece double-sided tape placed in base of wig cap at forehead and on both ear tabs
- using hairpins, place through nylon cap and wig on both sides and back of head
- roll on adhesive can be placed directly on scalp and washed off with water
What should I know about hair and scalp care during therapy?
- Shampoo with a mild shampoo and conditioner weekly.
- Pat dry gently with a towel, do not rub.
- Comb hair very gently.
- Avoid electrical hair appliances; let hair dry naturally.
- Consult your doctor before having any chemical processing done on your hair.
- Always protect your uncovered scalp with sunscreen when outdoors.
- Wear a night cap for sleep if you find you are losing body heat with an unprotected scalp.
- You might find that sleeping on a satin pillowcase may reduce friction.
Will my insurance cover my hair prosthesis?
While every insurance plan is different and there is no guarantee of coverage in all cases, these guidelines may assist you in obtaining insurance reimbursement.
- Get a prescription from your doctor.
- Prescription should read "Cranial/Hair Prosthesis for medical purposes. Alopecia secondary to chemotherapy or radiation therapy."
- Obtain a receipt from your salon or appearance center for fulfillment of the above prescription.
- Submit to insurance, prepare for denial of the claim.
- Resubmit if denied, include a picture of yourself without hair and request a review by medical review board. Send new claim to claim supervisor.
- Educate your insurance company. Explain that the prosthesis is needed as a medical necessity and is not cosmetic.
- Have your doctor write a letter on your behalf.
- Some centers will do the insurance billing for you.
- In Massachusetts, there is a law that provides for coverage of a hair prosthesis up to $350 per calendar year for anyone undergoing cancer treatment and has Massachusetts health insurance.
- Keep a copy of all correspondence, document telephone conversations (with dates and person spoken to) in writing. Most policies do not spell out exclusions under prosthetics; check your policy carefully.
What is a breast prosthesis?
A breast prosthesis or breast form is an artificial breast that is used after a surgery in which the breast has been removed or altered. A breast form may be worn to simulate the natural breast and body shape. Depending on the type of surgery, either full breasts or partial breasts can be purchased to balance the appearance. Breast prostheses usually come in silicone, foam, or fiberfill and are worn inside the bra or are attached to the body with a special adhesive.
Why would I need a breast prosthesis?
Many women dealing with breast cancer undergo surgery that alters their physical appearance. The common types of surgery include:
- Lumpectomy: which is the removal of a breast tumor and some of the breast
- Mastectomy: which is the removal of the breast tissue or the surgical removal of the breast tissue and underlying muscle.
A breast prosthesis is weighted and helps keep the body symmetrical when an imbalance is caused by breast surgery. When the body is not properly aligned back, shoulder, and neck discomfort may result. A breast prosthesis will help restore the body's natural balance and posture.
What are the advantages of having a breast prosthesis?
- May produce a more natural look under clothes
- May produce a more balanced look
- Helps prevent muscle-skeletal problems
- Keeps your bra from shifting
- Protects your chest and scars
- Gives you warmth
Added benefits of a custom breast prosthesis:
- The breast form is tailored to your own needs
- Precisely fits the chest wall
- Exactly distributes your weight
- May entirely alleviate stress and friction on sensitive areas of the chest wall
- More precisely matches skin tone, breast shape and areola size/color
How soon after surgery can I be fitted for my breast prosthesis?
You may make an appointment to be fitted as soon as you receive permission from your physician. (It usually takes 4-6 weeks)
What is a mastectomy bra?
A mastectomy bra is a bra that is specially designed with pockets to hold the weighted breast form. They come in a variety of attractive colors and styles and can be fitted at the same time as your breast prosthesis fitting.
Will my insurance cover my breast prosthesis and prosthetic bras?
For breast prostheses, get a prescription from your doctor stating your diagnosis, right or left breast prosthesis, and prosthetic bras. Medicare covers bras and prostheses as medically necessary. Most insurance companies cover breast prostheses and bras. Check with your insurance carrier for your specific coverage.
What is lymphedema?
Lymphedema is a swelling caused by the accumulation of lymph fluid and occurs when lymph vessels or lymph nodes are blocked or removed. Men and women who are undergoing cancer treatments that involve surgery and/or radiation that include the removal or damage of lymph nodes may be at risk for lymphedema.
What does the Friends Boutique carry for lymphedema?
Many patients are given prescriptions for garments made of a tight stretchy fabric that will provide compression for the affected limb. The sleeves do not act as pumps but rather prevent accumulation of more fluid in the limb. Different levels of compression are based on whether it's used for prevention or maintenance. A certified fitter must fit lymphedema garments to ensure a comfortable fit. Oftentimes patients will need more than one sleeve because therapy treatments and the lymphedema sleeve itself can alter the affected limb during this process. With daily use, sleeves wear out and must be refit and replaced about every 6 months.
Will my insurance cover my lymphedema garment?
For compression garments, get a prescription from your doctor stating your diagnosis, whether the garment is for your arm or hand and the amount of pressure for the garment. Most insurance companies cover lymphedema compression garments. Check with your insurance carrier for your specific coverage.
How should I take care of my nails?
Chemotherapy drugs sometimes cause mild, temporary changes in nails and nail beds. These may include: brittleness, grooving, discoloration, change in growth rate, heightened sensitivity, and lifting of the nail bed. If the latter occurs, nails should be kept short.
Nail Care Dos and Don'ts
- Most important: don't cut your cuticles. Use cuticle removers.
- Massage cuticle cream into the cuticle area to prevent dryness, splitting, and hangnails.
- Wear gloves while doing chores, such as washing dishes. Excessive exposure to water can lead to fungal infections of the nail bed.
- Wear nail polish to help keep nails strong and protected from the environment (and looking nice, too).
- Very dry nails can become weaker or more brittle during treatment. To take off polish, use an oily remover.
- If you're undergoing chemotherapy, avoid artificial nails.
- Alert your doctor to any signs of inflammation or infection.
- Ask a professional manicurist for more information on daily home care to keep your nails healthy and strong.
What happens when eyebrows and eyelashes are lost?
- Eyebrow and eyelash loss does not always occur; it is dependent upon the kind of therapy being administered.
- A stencil of your eyebrow can be created, before loss occurs.
- Pre-made stencil eyebrow kits are also available for purchase at your salon or appearance center.
- Be sure all eye makeup is fresh and fragrance free.
- Skin tone may be altered by the therapy, so it may be necessary to change your foundation color.
- It is best to check with your nurse or physican prior to using false eyelashes due to a possible allergic reaction to the glue and also an increased risk of infection.
You may need to fill in thinning brows or recreate your brows entirely. Whatever your need, the trick is to find your natural eyebrow arch and use short, feathery strokes for a natural look. A close-up photo of yourself, taken before treatment, is a big help.
To recreate your natural brow line:
- Buy brush-on eyebrow color or a pencil in a shade that matches your hair color.
- Hold the pencil straight up against your nose, parallel to the inside corner of your eye. This is where the eyebrow should begin. Draw a dot just above the brow bone.
- Looking straight ahead, place the pencil parallel to the outside edge of the colored part of your eye. Place a dot where the highest part of the brow line should be.
- To define the outside edge of the brow, place the pencil diagonally from the bottom corner of your nose past the outside corner of your eye and draw a dot. Be sure the outer edge of the brow is not lower than the inside one, as this will create a down-turned expression.
- Once you have the basic shape right, connect the dots into a brow line with feathery strokes of color, making the brow fuller on the inside corner and thinning as it moves out. With practice, drawing an eyebrow is as simple as applying lipstick (really!).
How should I take care of my skin?
During Chemotherapy...
- Some women experience very dry skin. If you're one of them, use mild soaps and lukewarm (not hot) water, or mild cleansing lotions or creams.
- Moisturize! Apply moisturizer while your skin is still damp and take special care of the sensitive area around eyes and lips.
- Avoid all types of hormone creams (such as products containing hydrocortisone).
- Avoid prolonged sun exposure and use sunblock with an SPF of 15 or higher (many moisturizers include sunscreen) unless otherwise directed by your doctor.
- Consult a cosmetologist for specific techniques to improve the look and feel of your skin during treatment.
During Radiation...
- It's essential to leave the marks your doctor or radiation therapist may have applied. Don't worry: they will eventually fade away. In the meantime, use warm water without soap or creams in the treatment areas.
- Most radiation oncologists prefer that their patients receiving radiation to the breast wear only cotton bras with no underwires.
- Avoid exposing treated areas to the sun. Do not use sunscreens on them until all your radiation treatments are completed, unless your doctor approves.
- If the treatment areas itch, tell your radiation therapist. A light sprinkling of cornstarch may help. Some creams and lotions may leave a coating that can interfere with your treatment. Use only those products which have been approved or prescribed by your doctor. Do not scratch skin near the treatment area.
- Temporary pigmentation changes, such as redness or tanning, may occur during treatment. Check with your doctor about using cosmetic concealer.
- Do not use cosmetics, perfumes, or deodorants on treated areas before checking with your radiation therapist. A non-metallic deodorant is usually recommended.
- Avoid extremes in temperature on treated areas (no heating pads or cold packs).
- Avoid shaving the treated skin until treatments are completed and the skin has recovered. If you must shave, use an electric razor.
- If your skin is still irritated after your radiation treatment is completed, ask your radiation therapist to recommend a moisturizer and sunscreen.
- Immediately inform your doctor of any signs of infection or changes in skin color.
Do I need to make an appointment before coming into the Boutique?
Appointments are encouraged. If we are able to accommodate walk-ins we will be more than happy to help you. Making an appointment for a wig fitting, breast prosthesis, bra fitting, or compression garment is helpful to us so that we can ensure that you can be given full attention without waiting. Secondly, by scheduling ahead we can verify the necessary prescription and insurance information, which will minimize your waiting time when you do come in for your fitting consultation. You can be confident that we will make every effort to accommodate your needs.
Do I need to bring a prescription to my appointment at the Boutique?
Because many of the items are covered by your insurance, you will need to get a prescription from your doctor and either bring it with you on the day of your appointment or fax it to us prior to your appointment at 617-632-2216.
A typical prescription for a breast prosthesis and bras would say the following:
"Breast prosthesis for (right, left, or bilateral) and (quantity) prosthetic bras for diagnosis and (quantity)."
A typical prescription for a hair prosthesis would say the following:
"Hair prosthesis for (diagnosis)"
A typical prescription for a lymphedema garment would say the following:
"Compression garment for (arm, hand) (right, left, bilateral), for (diagnosis). Compression of (amount of pressure to be specified by doctor, generally 20-30mg 0r 30-40 mg.)"
Why doesn't the Friends Boutique sell wigs, mastectomy bras and prostheses, and compression garments over the Internet?
Because of the sensitive nature of the products, we suggest that a certified fitter fit these types of products. Every woman's body is different. Expert fitters have worked with hundreds of different body types and know the products that are available and can provide a woman with the best professional fit. Often there is more than one option and that cannot be determined without trying things on. We encourage you to find a place that has certified fitters who have a lot of experience.
