Purpose of Review <p>Chemotherapy-induced alopecia remains one of the most distressing adverse effects of systemic therapy for breast cancer. Scalp cooling has emerged as the only evidence-based intervention to reduce hair loss during chemotherapy, yet its efficacy, tolerability, and implementation continue to evolve.</p> Recent Findings <p>Over the past decade, randomized trials and large prospective cohorts have demonstrated that scalp cooling significantly reduces alopecia, particularly with taxane-based regimens, while outcomes remain more variable with anthracycline-containing therapy and newer agents such as antibody–drug conjugates. Real-world studies confirm acceptable tolerability and high patient satisfaction among those achieving hair preservation. Emerging data highlight disparities in access and utilization, as well as growing policy efforts to improve insurance coverage.</p> Summary <p>Scalp cooling is an effective supportive care strategy for many patients with breast cancer, with meaningful benefits for quality of life. Ongoing studies of newer devices, modern chemotherapy regimens, and comparative effectiveness will further refine patient selection and implementation in contemporary practice.</p>