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The bone flap and the plates that hold it | CION Cancer Clinics
In most craniotomies the piece of skull that is lifted out, called the bone flap, is put back before the operation ends. Small titanium plates and screws hold it steady while the bone heals, and they usually stay for life without trouble. Sometimes the bone is left out for a while. This page explains both, what you may feel under the scalp and when to call your team. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What happens to the piece of skull that is removed?
- How is the bone taken out and put back?
- What happens if the bone flap is not put back straight away?
- What might you notice, and what does it usually mean?
- What do the words on your surgery report mean?
- What do people believe about skull plates, and what is true?
- When should you worry, and what can this page not tell you?
- Common questions about the bone flap and plates
The short answer
What happens to the piece of skull that is removed?
In most craniotomies, the piece of skull is put back at the end of the same operation. It is held in place with small, flat metal plates and screws, usually made of titanium, which stay in for life and rarely cause any trouble.
What a bone flap is
To reach the brain, the surgeon cuts out a window of bone from the skull. This piece is called the bone flap. It is kept clean during the operation and then fitted back into the same space, like replacing a lid.
How the bone heals
The plates hold the flap still while the edges knit to the rest of the skull. This happens slowly over many months, much as a broken bone heals. The plates are there to hold it steady while that happens, and they are not usually removed afterwards.
When it is different
Sometimes the flap is left out for a while, most often because the brain is too swollen to close safely, or because of infection. That operation is called a craniectomy, and the bone is replaced in a later operation. Your surgeon will tell you which one you had.
Your discharge summary says whether the bone was replaced. Keep a copy with you, especially for future scans.In the operating theatre
How is the bone taken out and put back?
Small holes first
After folding back the scalp, the surgeon drills one or more small holes in the skull. These are called burr holes. You are fully asleep for this in most operations.
Cutting the window
A fine saw joins the holes to lift out the bone flap. The flap is kept safe while the surgeon works on the brain beneath.
Fitting it back
The flap goes back in its space. Small plates, each about the size of a fingernail, bridge the gap between the flap and the skull.
Closing the scalp
The muscle and scalp are laid back over the bone and closed with stitches or clips. The plates lie under the skin and cannot be seen.
Not sure whether this applies to you?
Ask an oncologistWhen the bone stays out
What happens if the bone flap is not put back straight away?
This is less common after planned surgery for a tumour. When it happens, there are a few ways the gap is managed.
The bone is stored
Your own flap may be kept frozen in a hospital bone store, or placed under the skin of the tummy to keep it alive. It is put back once the brain swelling settles.
A made-to-measure implant
If the bone cannot be used, a replacement shaped from your scan is fitted instead. It may be titanium mesh, a hard medical plastic or a bone cement.
Ask your centre which materials they use and why. Not every centre offers every type.Protecting the gap
Until the bone is back, the brain sits under soft scalp only. You may be asked to wear a soft helmet when up and about, and to avoid lying on that side.
The second operation
Replacing the bone is called cranioplasty. It is usually shorter than the first surgery, but it is still an operation with its own risks, and timing is set by your surgeon.
Under your fingers
What might you notice, and what does it usually mean?
What you notice
What it usually means
Small hard bumps under the scalp
The edges of the plates or screws, felt through thin skin
A slight dip near the temple or over a hole
A gap at the bone edge, or thinning of the jaw muscle over it
A clicking or odd sensation in the first weeks
Often fluid or air under the scalp settling; mention it at follow-up
Aching over the plates in cold weather
Common, and usually eases with time
The flap area looks sunken or moves when pressed
Needs to be checked by your surgical team soon
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On your report
What do the words on your surgery report mean?
- Craniotomy
- An operation where a piece of skull is lifted out to reach the brain and then put back.
- Craniectomy
- The same opening, but the bone is left out for now.
- Cranioplasty
- A later operation to close the gap, with your own bone or an implant.
- Burr hole
- A small round hole drilled in the skull. It may leave a tiny dip under the scalp.
- Bone flap resorption
- The replaced bone slowly thinning or softening. It is uncommon and is watched for on follow-up scans.
Commonly believed
What do people believe about skull plates, and what is true?
"With metal in your head you can never have an MRI."
Titanium plates are not magnetic, and most people with them have MRI scans safely, often many times. Always tell the scan team about any implant, and bring your surgery report.
"The plates will set off every airport alarm."
The plates are small, and they rarely trigger airport scanners. If you are worried, carry a copy of your discharge summary. Ask your surgeon when it is safe to fly at all.
"The head will always be fragile where the bone was cut."
Once healed, a replaced flap is firmly joined. Your surgeon will still advise on contact sports, heavy lifting and when to return to riding a two-wheeler.
"The plates have to come out later."
They are designed to stay for life. They are removed only in rare cases, such as infection or a plate pushing on thin skin.
Living with it
When should you worry, and what can this page not tell you?
Most people forget the plates are there once the scalp has healed. The things to act on are the signs of a problem with the bone or the wound underneath.
Call your team the same day if
The skin over the flap turns red, hot or starts to ooze, a plate seems to be pushing through the skin, or clear fluid leaks from the wound. The same goes for a fever, a swelling that keeps growing, or new drowsiness, confusion or a fit. Infection of the bone flap is uncommon, but it can appear weeks or even months after surgery.
Who this does not describe
People who have had radiotherapy to the same area, or several operations through the same opening, have thinner scalp and slower bone healing. Their surgeon may give different advice.
What this page cannot tell you
It cannot tell you which plates or implant were used in your operation, or whether your own flap has healed. Only your report, examination and scans can answer that.
Questions we are asked
Common questions about the bone flap and plates
Will I be able to feel the plates?
Some people can feel small bumps under the scalp, especially where the skin is thin, on the forehead or in someone who has lost weight. This is normal and not a sign of a problem. What does need checking is a plate that seems to be pushing through the skin, or redness and oozing over it.
Are titanium plates safe for MRI and CT scans?
Yes, in almost all cases. Titanium is not magnetic, so MRI is generally safe. The plates may cause a small blur on the images near them, which the radiologist reads around. Always tell the scan team about any implant and show your surgery report, especially if a different material was used.
Can the bone flap move if I bump my head?
The plates hold the flap firmly, and an ordinary knock is unlikely to move it. Still, avoid contact sports and heavy strain until your surgeon clears you. After any hard blow to the head, or if you notice new swelling, headache, sickness or drowsiness, get checked the same day.
I was told the bone is being kept for later. What does that mean?
It means you had a craniectomy, and your own bone is being stored to be put back in a later operation. Ask where it is kept, roughly when the surgeon plans to replace it, and what to do to protect your head until then. Keep all paperwork about the stored bone safely.
Why is there a dent near my temple?
A dip near the temple is common after surgery on the side of the head. The jaw muscle that lies there is lifted during the operation and can thin a little, and small gaps can remain at the bone edge. It is usually a cosmetic change. Mention it at follow-up if it bothers you.
Can the plates rust or cause an allergy?
Titanium does not rust inside the body, and true allergy to it is very rare. If you have a known metal allergy, tell your surgeon before the operation so they can plan for it. Redness or swelling over a plate later on is more often infection or skin irritation, and should be checked.
When can I ride a two-wheeler or wear a helmet again?
Your surgeon decides this. It depends on whether the bone was replaced, how the wound has healed, and whether seizures or driving rules apply to you. Riding also needs clearance to drive. A helmet should not press on a healing wound, so ask at your follow-up rather than guessing.
Is the operation to replace the bone risky?
Cranioplasty is usually a shorter operation than the first one, but it has real risks, including infection, fluid collecting and problems with the bone or implant. Your surgeon can explain the risks that apply to you, and why they have chosen the timing and material they have.
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Sources
- Cancer Research UK — Brain tumours
- American Cancer Society — Brain and spinal cord tumors in adults
- National Cancer Institute — Brain tumors
- NHS — Brain tumours
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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