"She will eventually be able to eat a hamburger, something she said was very important her, having only had pureed food since her injury, and I think we can all relate to that," Dr. Bohdan Pomahac said.
A 30-member surgical team under the leadership of Pomahac at Brigham and Women's Hospital performed a full face and double hand transplant on Charla Nash late last month, but the hands failed to thrive as she struggled with pneumonia and were removed.
But overall, her recovery and future look excellent, Pomahac said.
Nash's was the third full face transplant in the U.S.
Her skin, underlying muscles, blood vessels and nerves were replaced along with her hard palate and teeth.
Over the next several months she will develop more control over facial muscles and more feeling, letting her breathe through her nose and develop her sense of smell. She remains blind.
Her brother Steve Nash later said his sister wants to enjoy hot dogs and a slice of pizza from their favorite pizza parlor in Poughkeepsie, N.Y., the town where they spent their childhood.
While the loss of her transplanted hands was disappointing, Pomahac said she could undergo another hand transplant in the future.
He said her left arm was replaced at the mid-forearm. Her right hand was replaced at the wrist, except for the thumb, which was all she had left after the February 2009 attack.
The right hand replacement was "technically challenging," he said, because a partial transplant had never been done.
Several days after the operation, Nash developed pneumonia and suffered a drop in blood pressure, which compromised blood flow to the hands. Doctors eventually had to remove the transplanted hands.
Charla Nash will also be able to go out in public without feeling self-conscious, Pomahac said. She had to skip her only daughter's high school graduation last spring because she was concerned that she would become the center of attention.
"We know it broke her heart," Pomahoc said, pausing to control his emotions. "I think her new face will allow Charla to be present when Briana graduates from college in a few short years,"
Steve Nash, fighting back tears, called the operation "miraculous." "We are confident Charla will gain her goal to regain her health and independence in the future," he said.
The name of the donor was not disclosed to maintain her family's privacy.
The donor can be as much as 20 years younger or up to 10 years older than the recipient and must have the same blood type and similar skin color and texture.
Experts not connected with the Boston case said it was medically riskier than previous transplants, but not unethical.
"Hand transplants and face transplants are big operations. When you combine the two big operations, it can be a challenge," said Dr. Joseph Losee of the University of Pittsburgh, which has done three double and two single hand transplants and is preparing to offer face transplants soon.
Dr. Warren Breidenbach, who led the nation's first hand transplant, in 1999, at Jewish Hospital and the University of Louisville, said:
"It is completely ethical, and the proper thing to do, to do the face and the hands at the same time."
Doing them separately, or attempting another hand transplant for Nash in the future, raises the risk of rejection because tissue from two different donors would be involved, said Breidenbach, who is now chief of reconstructive and plastic surgery at the University of Arizona.
The 200-pound pet chimpanzee, named Travis, went berserk in February 2009 after its owner asked Nash to help lure it back into her Stamford, Conn. house. It ripped off Nash's hands, nose, lips and eyelids, blinding her before being shot and killed by police.
The owner, Sandra Herold, has speculated that the chimp was trying to protect her and attacked Nash because she had changed her hairstyle, was driving a different car and was holding a stuffed toy in front of her face to get Travis' attention.
Nash's family is suing the estate of the chimp's owner, Sandra Herold, for $50 million and wants to sue the state for $150 million, saying state officials failed to prevent the attack. Herold, who had a tow truck business, died last year of an aneurysm.
About a dozen face transplants have been done worldwide, in the U.S., France, Spain and China.
There have been two other full-face transplants performed in the U.S., both at Brigham and Women's Hospital. Dallas Wiens became the nation's first full-face transplant patient there in March.
The 25-year-old Fort Worth, Texas man received a new nose, lips, skin, muscle and nerves from an unidentified dead person in an operation paid for by the U.S. military, which wants to use what is learned to help soldiers with severe facial wounds.
Wiens' features were all but burned away and he was left blind after hitting a power line while painting a church in November 2008.
Mitch Hunter, a 30-year-old Indiana man, received the surgery in April.
Hunter's face was severely disfigured and burned during a car accident that toppled high-voltage electrical wires. He also lost his left leg below the knee and two fingers.
