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Gabrielle Giffords
AP file
Rep. Gabrielle Giffords, seen here in a March 2010 photo, is undergoing surgery to replace a missing piece of her skull with a plastic implant, sources say.
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updated 5/18/2011 11:24:23 PM ET 2011-05-19T03:24:23

Doctors repaired Gabrielle Giffords' skull, the latest milestone in her recovery from an assassination attempt and a procedure that experts say will improve her quality of life.

A gunman shot the Arizona congresswoman in the head more than four months ago in Tucson, Ariz., and doctors had to remove a portion of her skull to relieve pressure on her brain.

On Wednesday, they put a plastic implant in place to fully cover her brain, according to a statement from TIRR Memorial Hermann hospital. The hospital planned a briefing on Thursday to give an update on her medical condition and discuss the next steps in her rehabilitation.

Giffords is "recovering well after her surgery today," a hospital statement said.

Giffords' astronaut husband, Mark Kelly, is orbiting Earth on space shuttle Endeavour and is getting updates on her condition, NASA said.

Doctors familiar with the procedure and not involved in her care said it was fairly routine, will significantly improve her quality of life and help her feel more normal.

"It's a very significant milestone in the recovery," said Dr. Robert Friedlander, chair of neurosurgery at the University of Pittsburgh Medical Center.

The implant — or bone flap, as doctors call it — will protect the brain and the skull, Friedlander said. It will allow Giffords to freely move about without her helmet, adorned with the Arizona state flag, for the first time since she began therapy in late January.

In addition, it makes therapy easier because the helmet can be uncomfortable and cumbersome, Friedlander said.

Dr. Reid Thompson, chairman of neurological surgery at Vanderbilt University Medical Center in Nashville, said there is also an important psychological element to removing the helmet.

"They look in the mirror and they don't see someone who's been injured or shot. They look normal," Thompson said.

The flap itself is custom made, manufactured to slip perfectly into place based on a three-dimensional model of the skull built from a CT image, Thompson said. Usually, the implant is made of clear or white plastic, and tightened into place with titanium screws.

'She'll look like everyone'
Bill Kolter, a spokesman for Biomet, the manufacturer of Gifffords' implants, said the material is porous to allow bone to fuse to the edges of the object in the future. "She'll look like everyone and when walking down the street you wouldn't know." Thompson said.

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Even the shunt — or tube — placed in Giffords' head to drain excess spinal fluids from her brain will not ruin the image, Friedlander said.

That tube, which is permanent, is generally placed in the front of the head and is no more than a small bulge under the skin, usually hidden by hair. The tube drains the fluid into the abdomen.

"Externally ... once the swelling is gone, her head will be nice and round the way she was beforehand," Friedlander said.

From the start, doctors have marveled not only at Giffords survival, but also at her recovery.

Within weeks of arriving at TIRR Memorial Hospital in late January, Giffords' family and staff reported she could speak a few words, then sing some songs and string together short sentences. By March, she was able to walk with assistance, according to her doctors, and her personality was shining through.

On Monday, according to her staff, she said "good stuff, good stuff" while watching her husband rocket into space.

Still, doctors caution that she has a long recovery ahead of her and have repeatedly talked about reaching a new "normal."

Fairly routine procedure
Wednesday's operation is considered fairly routine, though there is a 1 percent chance of infection or bleeding, Thompson said. Infection, normally resulting from the introduction of a foreign body, would not be apparent for a few weeks, but bleeding could occur in surgery when doctors lift the skin to reach the open area, Friedlander added.

Yet doctors say it wasn't necessary to have Kelly on Earth to go ahead with the surgery.

Not only can closing the hole alleviate some of the headaches associated with brain injuries, it helps prevent any future injury, Thompson said.

The surgery itself is only about 90 minutes long. From start to finish, including recovery from anesthesia and pre-operating preparations, the procedure takes no more than three hours, the doctors said.

And once it's over, the real countdown for Giffords' release will begin, they added. "That may actually be quite soon," Thompson said.

© 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Photos: Former Ariz. Representative Gabrielle Giffords

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  1. Gabrielle Giffords, the former congresswoman who was shot and left handicapped after a gunman opened fire at an event in Tucson, Ariz., and her husband retired Navy Capt. Mark Kelly prepare to testify before a Senate Judiciary Committee hearing on gun violence in Washington, D.C., on Jan. 2013. (Jim Lo Scalzo / EPA) Back to slideshow navigation
  2. U.S. Senator Richard Blumenthal, D-Conn., former U.S. Rep. Gabrielle Giffords and her husband, former astronaut Mark Kelly, leave the Newtown Municipal Building in Newtown, Conn. on Jan. 4, 2013. Giffords met with Newtown officials on Friday afternoon before heading to visit with families of the victims of the Sandy Hook Elementary School massacre. (Michelle Mcloughlin / Reuters) Back to slideshow navigation
  3. Gabrielle Giffords waves to the Space Shuttle Endeavor with her husband, former astronaut Mark Kelly as it flies over Tucson, Ariz. on its way to Los Angeles, on Sept. 20, 2012. Kelly served as Endeavour's last space commander months after Giffords survived serious head injuries because of a 2011 shooting. (P.K. Weis / Southwest Photo Bank via AP) Back to slideshow navigation
  4. Gabrielle Giffords blows a kiss after reciting the Pledge of Allegiance during the final session of the Democratic National Convention in Charlotte, N.C. on Sept. 6, 2012. (Eric Thayer / Reuters) Back to slideshow navigation
  5. Gabrielle Giffords stands on top of a peak in the French Alps with her husband Mark Kelly, right,, and mountain guide Vincent Lameyre, July 23, 2012. On her first trip out of the country since her injury in 2011, she rode a two-stage cable car to a station for spectacular views of Mont Blanc. (Denis Balibouse / Reuters) Back to slideshow navigation
  6. Ron Barber, right, celebrates his victory with Giffords, left, prior to speaking to supporters at a post election event, Tuesday, June 12, 2012, in Tucson, Ariz. Barber, Giffords' former district director, won her seat in a special election after she resigned to focus on her recovery. (Ross D. Franklin / AP) Back to slideshow navigation
  7. Democratic Florida Rep. Debbie Wasserman Schultz, read Rep. Gabriell Giffords resignation speech on the House floor on Wednesday, Jan. 25, 2012. The day after President Obama's State of the Union speech, Giffords formally offered her resignation to Speaker John Boehner. Weeping, Shultz applauded the strength of her friend and colleague, "I'm so proud of my friend." (MSNBC) Back to slideshow navigation
  8. President Barack Obama hugs retiring Congresswoman Gabrielle Giffords as the president arrives to deliver his State of the Union address on Tuesday, Jan. 24, 2012. (Pool / Reuters) Back to slideshow navigation
  9. Rep. Gabrielle Giffords, D-Ariz., left, and Pelosi, right, posing with Giffords husband, former astronaut Mark Kelly of the Navy, at his retirement ceremony with Vice President Joe Biden in the Old Executive Office Building on the White House complex in Washington, Thursday, Oct. 6, 2011. (House Leader Nancy Pelosi's office / AP) Back to slideshow navigation
  10. Rep. Gabrielle Giffords returns to the House for the first time since she was shot, making a dramatic entrance on Monday, Aug. 1, 2011, during a crucial debt vote. She drew loud applause and cheers from surprised colleagues. (NBC News) Back to slideshow navigation
  11. Rep. Gabrielle Giffords poses for a photo the day after the launch of NASA space shuttle Endeavour and the day before she had her cranioplasty surgery, outside TIRR Memorial Hermann Hospital May 17, in Houston, Texas. Aides of Rep. Gabrielle Giffords posted two recent photos of the congresswoman to her public Facebook page, the first since the January 8 shooting that killed six people and wounded a dozen others. (P.K. Weis / Giffords Campaign / Getty Images) Back to slideshow navigation
  12. Emergency workers use a stretcher to move Rep. Gabrielle Giffords after she was shot in the head outside a shopping center in Tucson, Ariz., on Saturday, Jan. 8, 2011. (James Palka / AP) Back to slideshow navigation
  13. In this Jan. 5, 2011 file photo, House Speaker John Boehner re-enacts the swearing in of Rep. Gabrielle Giffords on Capitol Hill in Washington. (Susan Walsh / AP) Back to slideshow navigation
  14. Rep. Giffords, left, speaks during a candidates debate with Republican candidate Jesse Kelly at the University of Arizona in Tucson, Ariz., on Oct. 18, 2010. Kelly is an Iraq War veteran and was the Tea Party favorite for the 8th congressional district seat. (Joshua Lott / The New York Times via Redux Pictures) Back to slideshow navigation
  15. Rep. Gabrielle Giffords meets with constituents in Douglas, Ariz., in 2010. Giffords, 40, took office in January 2007, emphasizing issues such as immigration reform, embryonic stem-cell research, alternative energy sources and a higher minimum wage. (Reuters) Back to slideshow navigation
  16. Rep. Giffords speaks during a press conference in Washington, D.C., where members of Congress called on the President to secure the border with the National Guard on April 28, 2010. (James Berglie / Zuma Press) Back to slideshow navigation
  17. This picture provided by the office of Rep. Gabrielle Giffords on Monday, March 22, 2010, shows damage to her office in Tucson, Ariz. The congressional office was vandalized a few hours after the House vote overhauling the nation's health care system. (AP) Back to slideshow navigation
  18. Rep. Gabrielle Giffords, D-Ariz., center, gives a tour of Statuary Hall in the Capitol to Shuttle Discovery STS-124 astronauts Mission Specialist Akihiko Hoshide, of Japan, and her husband, Commander Mark Kelly, on Thursday, July 17, 2008. (Bill Clark / Roll Call Photos) Back to slideshow navigation
  19. From right. Rep. Ken Calvert, Rep. Dennis Moore, Rep. Gabrielle Giffords, and Rep. Heath Shuler, attend a House Ways and Means Subcommittee on Social Security hearing on current and proposed employment eligibility verification systems on May 6, 2008. The hearing provided a forum for lawmakers on both sides of the immigration debate, focusing on a system to verify the legal status of workers and job applicants. (Scott J. Ferrell) Back to slideshow navigation
  20. Gabrielle Giffords with U.S. Navy Cmdr. Mark Kelly, a NASA astronaut, at their wedding in Amado, Ariz., on Nov. 10, 2007. Kelly's twin brother, also an astronaut, is a commander on the International Space Station. "We have a unique vantage point here aboard the International Space Station. As I look out the window, I see a very beautiful planet that seems very inviting and peaceful. Unfortunately, it is not," said Scott Kelly of the tragedy that befell his sister-in-law. (Norma Jean Gargasz for The New York Times / Redux Pictures) Back to slideshow navigation
  21. Representatives-elect including Dean Heller, top right, and Gabrielle Giffords, next to Heller, prepare for the freshman class picture for the 110th Congress on the House Steps on Nov. 14, 2006. (Tom Williams / Roll Call Photos) Back to slideshow navigation
  22. Rep. Gabrielle Giffords rides horseback in 2006. In an interview with NPR last year, she recalled working with horses during her adolescence in Tucson. "I loved cleaning out the stalls, and I did that in exchange for riding lessons. And I continue to ride most of my life. And I learned a lot from horses and the stable people ... I think it provided good training, all of that manure-shoveling, for my days in politics ahead." (Reuters) Back to slideshow navigation
  23. A page entitled, "Just do it!" in La Semeuse, the Scripps College yearbook in 1993. The photo at right shows Giffords in traditional Mennonite clothing. That same year, she won a Fulbright award to study Mennonites and other Anabaptist groups in Northern Mexico. Gifford's senior thesis was titled "Wish Books and Felt-Tipped Fantasies: The Sociology of Old Colony Mennonite Drawings." (Scripps College) Back to slideshow navigation
  24. Gabrielle Giffords' senior portrait from the 1993 Scripps College yearbook. Giffords double-majored in Latin American studies and sociology. A Dean's List student, Gifford won several awards during her time at Scripps. (Scripps College) Back to slideshow navigation
  25. Gabrielle Giffords, right, laughs with her mom, Gloria Kay Fraser Giffords, in a photo published in the Scripps College yearbook. Gabrielle received a B.A. in Sociology and Latin American history from Scripps College in Claremont, Calif. in 1993. (Scripps College) Back to slideshow navigation
  26. University High School portrait of Gabrielle Giffords, class of 1988. Dr. John Hosmer, taught history to the future lawmaker. He tells msnbc.com, "Gabrielle sat in the front row. She was inquisitive ... She was a very mature person from the moment she walked in the door." (University High School) Back to slideshow navigation
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Video: Giffords watches husband’s final launch

  1. Closed captioning of: Giffords watches husband’s final launch

    >>> and a day full of emotion at the kennedy space center as recovering congresswoman gabby giffords watched her husband's last scheduled launch into space.

    >> four, three, two -- and liftoff for the final launch of "endeavour." expanding our knowledge, expanding our lives in space.

    >> it was a picture perfect blastoff for shuttle "endeavour's" last mission. it is headed to the international space station with billions of dollars in research equipment and a los angeles museum will be its home once it is retired. congresswoman giffords was eager to tell the world about the launch tweeting good morning, who is ready for the best show on either? pia is gabby giffords chief of staff and was with the congresswoman for the launch. thank you for joining me.

    >> no problem.

    >> how did it feel to be there with your boss?

    >> it was terrific. it was a beautiful day here at kennedy space center , and we saw the shuttle blast off. you know, it created a beautiful streak in the sky and the noise was obviously loud and, you know, really nice mood up on the roof this morning on the launch control center . the congresswoman was there with the other spouses and her mother, mark's daughters and his brother scott. it was a great day all around.

    >> we always hope for the best and wanted her to be there and we know that there was the delay of the initial launch. i don't know, in the back of your mind did you just think, maybe this won't come true? it's too wonderful to come true in a sense and then it becomes a reality.

    >> yeah. for sure. and this morning when there was some cloud cover at 7:30 a.m . this morning, we weren't sure whether or not the shuttle would actually go. this might get scrubbed again. until it actually happens, you know, you wonder whether or not it's actually going -- they're going to light the rocket and send it off.

    >> so much is out of your control. tell me a little bit about congresswoman's -- her recovery thus far. we've heard she started to walk. obviously, this was an incredible trip for her to make. where does she stand now in her recovery as you have watched her these many weeks now?

    >> well, she's doing very well. she's continuing her rigorous program in houston. they've got her on a busy schedule every day of physical and speech and cognition therapy and it's really making a difference. and this trip to florida, this weekend and for the first launch attempt two weeks ago, are really not breaks in her therapy. it's just a different type of therapy because she's moving around in different environments. she's meeting new people. so it's challenging in a new way, and we've really seen her respond very well. she's happy to be here and, you know, there's a lot of adrenaline and excitement running through the whole astronaut family right now.

    >> thank you for giving us an account of what you witnessed today. a picture perfect day and we were all happy that it went off without a hitch. thank you so much, pia.

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