Knuckle in implant. What can I do? What is a knuckle in an implant?

At my 6 week check up I told my plastic surgeon that I felt a soft protruding lump on my right breast. He informed me that it was a knuckle in my implant. And than stated that there was nothing he could do about it! I'm very upset because it seems to be worse now that my breasts have settled more. It is now visable when I wear a bathing suit. What can I do? What is a knuckle in an implant?

Doctor Answers 5

Knuckle or Fold in Implant

Thank you very much for your question. Your surgeon used the term knuckle to refer to a fold in the shell of your implant. Unfortunately, there is no way to correct a fold, so the implant may need to be replaced. Without an in-person examination, it is difficult to provide any meaningful advice on your personal situation. My recommendation would be to follow your operating surgeon’s recommendations, or schedule a consultation with a second, board certified plastic surgeon.  

Houston Plastic Surgeon
4.8 out of 5 stars 109 reviews

Implant palpability

Often implants are palpable in the lower pole. You would have to be examined in person to see how this appears or feels.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Knuckle in Implant


Thank you for your question. What you are referring to is caused by a crease or fold in the implant shell. Releasing the pocket to provide space for the implant to spread out, or replacing the implants with larger/firmer ones could improve this for you.

All the best

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Palpable and visible "knuckle" in a breast implant

Breast implants are designed to be soft and compressible, which helps an augmented breast feel natural and soft. Occasionally a soft implant can be compressed and folded inside the scar "capsule" that surrounds the implant. This results in a palpable and occasionally visible "knuckle" or fold in the breast implant. The likelihood of a fold being palpable or visible is greater if there is little soft tissue thickness (breast gland or fat) covering the implant. In some of these cases an exploration of the implant pocket can be performed and the tight capsule released to allow for more room for the implant and thus less folding of the implant. There are also new types of implants that are firmer and less likely to fold, and these maybe an option in some patients. There are also tissue grafts that can be used as extra thickness to mask the palpability of an implant in very thin patients. All of these options have risks and benefits, so a discussion with your Plastic Surgeon or a Plastic Surgeon with experience in breast revision surgery would be very important!

Douglas Leppink, MD
Grand Rapids Plastic Surgeon
4.8 out of 5 stars 26 reviews

Knuckle in implant. What can I do? What is a knuckle in an implant?

Hello lillori225,

Thank you for your question, and I am sorry to hear about this.  It is difficult to say without photos or an exam, but it appears that the implant has a small crease or fold in it that is causing the "knuckle".  Most implants are composed of an inner gel well below the maximum fill amount in order to provide a softer, more natural feel.  However, if these devices are not fit into a snug pocket then the outer shell can develop a crease.  The latest cohesive gell implants decrease the chance of a "knuckle" forming as the gel is not as viscous.  Also, Inspira implants are filled to roughly 95% maximum fill volume to limit the possibility of a crease forming.

Please continue to discuss with your plastic surgeon. 

Hunter Moyer, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 17 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.