Holding on to herself — and her hair — during breast cancer treatment

She had just turned 40 and was raising four young children. She also worked as a marketing director and had started a new business with her sister-in-law. An avid fitness lover, she had always been active and enjoyed running, biking, and workout classes.

Within days of her self-exam, she was diagnosed with stage I, grade 3 triple-negative breast cancer. The tumor was small and had not reached her lymph nodes, but the aggressive subtype meant she would undergo 16 rounds of chemotherapy and immunotherapy. She also elected to have a double mastectomy.

During the whirlwind of appointments and decisions, Marisa stayed focused on what she could control. One of those decisions was whether to try scalp cooling, also known as cold capping, to preserve her hair.

Saying yes to scalp cooling

Marisa had already heard of cold capping from various sources. She spoke to friends and acquaintances who had been through breast cancer. Many had been told scalp cooling wouldn’t work with their chemotherapy regimen. Online research wasn’t encouraging. Based on her medications, one online calculator gave her just a 30% chance of keeping her hair.

“But I just thought, I’m not going to accept that,” she says. “This was my way of trying to take some control in a situation in which I felt like I had none. Even if it didn’t work, I would know I tried.”

Marisa’s oncologist was supportive. Her hospital offered manual cold capping using gel caps frozen with dry ice. The caps had to be changed every 20 to 25 minutes before, during, and after chemo. Marisa chose to hire a professional cold capping company.

Each treatment became a full-day commitment. Capping began one hour before infusion and continued for four to five hours after: seven hours total. She brought a heated blanket and a heating pad for her face to manage the extreme cold.

“It was the worst brain freeze you’ve ever had in your life,” she says.

At home, she followed every aftercare instruction precisely. She washed her hair only once or twice a week, using cold water. She avoided all heat styling. Brushing her hair was minimal. The regimen was strict.

She stuck with it.

The results: She lost some hair, especially around her hairline, but retained about 70% overall.

“It’s not for the faint of heart,” she admits.

Preserving normalcy and privacy

For Marisa, the benefits of cold capping went far beyond appearance. Her four children, ranging in age from toddlers to early elementary schoolers, couldn’t fully understand what was happening.

“There were so many parts of treatment my children couldn’t see or understand: my port, my scars, the fatigue,” she says. “But keeping my hair helped them see me as the same mom.”

Later, she realized how much normalcy she had preserved. Sitting in the hospital cafe between appointments, she ran into a close friend of her mother-in-law. The friend was surprised to see her at the hospital and asked what she was doing there.

After a moment’s hesitation, Marisa explained her diagnosis and that she had been through seven rounds of chemotherapy. She noticed the friend’s eyes glancing up at her hair. “Most people associate chemo with being bald,” she says. “She would have had no idea if I hadn’t told her.”

“Cold capping gave me privacy,” she adds. “It let me choose who to tell and when.”

Insurance and access to scalp cooling

Marisa paid out of pocket for cold capping, including the equipment rental, supplies, and professional cold capping services. Insurance covered none of it.

Marisa thinks that insurance companies should provide coverage. “It’s not cosmetic. It’s a medical device in a hospital setting that can require assistance to use." She adds, "Cancer strips you of so much. Being able to hold onto something of yourself helps you feel better mentally, which helps with healing.”

In the U.S., the federal government sets rules about what private health insurance must cover. Manual cold-caps, like Marisa used, are not regulated by the FDA. In recent years, new cold caps have been developed that use built-in cooling systems to keep the scalp at a steady temperature. These high-tech caps are easier to use and have strong scientific support.

Because they keep temperatures more consistent and have been tested in clinical trials, these newer cold caps are FDA-approved. The Centers for Medicare and Medicaid Services also see them as a helpful way to manage hair loss from cancer treatment. Some states are working to require that private insurers cover these advanced cold caps. If insurance doesn’t cover them, some patient assistance programs and other organizations can help cover the cost of scalp cooling as well.

Marisa encourages others to explore cold capping if it’s something they want to try. “If cost is a barrier, look into organizations that offer support. Help is out there.”

Back to Broad Street

Before her diagnosis, Marisa had run the annual 10-mile race in Philadelphia called the Broad Street Run six times. Even during chemotherapy, she stayed active, working out with her trainer and taking fitness classes when she could.

Marisa’s co-workers surprised her by organizing a breast cancer mud run in her honor, held the day before her double mastectomy.

“It wasn’t my fastest race by any means,” she says. “But I kept telling myself: If you can get through chemo, you can do anything. It was my last day of movement before surgery, and I got to spend it pushing through something hard, moving my body and supporting breast cancer survivors.”

She plans to run Broad Street again in 2026 and hopes to complete a marathon to raise funds for breast cancer research.

Today, Marisa is still undergoing immunotherapy. She still has her port and surgical scars. But she also has her family, her sense of self, and her voice.

She knows her choices won’t be right for everyone, but she hopes her story can be a reminder of what’s possible.

“If sharing my story makes even one woman stop and do a self-exam or realize they have options, then it’s worth it.”