The woman who received the world's first ever face transplant has died after suffering years of psychological torment following the groundbreaking surgery.

Isabelle Dinoire was left disfigured with her face nothing more than bloody shreds of flesh when her beloved pet Labrador, Tania, mauled her in an attack at her flat in Valenciennes, northern France, in May 2005.

Six months later Ms Dinoire, a seamstress, was heralded a medical miracle when doctors successfully replaced her nose, lips and chin, with those of Maryline St Aubert, a schoolteacher who reportedly hanged herself in nearby Lille.

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Medical miracle: Mother-of-two Isabelle Dinoire was left disfigured after she was mauled by her pet Labrador at her flat in Valenciennes, France, in May 2005, and later underwent the world's first face transplant. Above, Ms Dinoire three months (left) and a year after the surgery

Before the attack: Ms Dinoire, pictured a year before she underwent the procedure. She would later speak of the psychological torment she suffered in the years after the operation

Personal struggles: Ms Dinoire, pictured in 2009, four years after the historic transplant

But in the years after the surgery, away from the glare of the media spotlight, Ms Dinoire battled personal demons as she struggled to live with another woman's face.

She lived in fear of catching a glimpse of her own reflection and shied away from photographs of her former self, saying that she felt like 'half me and half her'.

Ms Dinoire, who divorced her husband before the operation, was also forced to take powerful immunosuppressant drugs to stop her body rejecting the transplant.

This medication left Ms Dinoire susceptible to cancer, which is believed to have taken her life in April of this year. She was 49.

A statement released today said her death had not been made public to protect her family's privacy.

Ms Dinoire's daughters, Lucie and Laure, were staying at their grandmother's house when they received a phone call from their mother just hours after the dog attack.

Donor: Maryline St Aubert, a schoolteacher who reportedly hanged herself

Concerned by her groggy manner the girls, then just 17 and 13, rushed home to find their mother in their darkened top-floor flat, surrounded by blood.

A degree of mystery still surrounds the events of May 2005, of which Ms Dinoire had no memory. Last year she admitted she was depressed and had taken sleeping pills to help her rest after a tough week. Media reports later suggested she had tried to kill herself.

After taking the medication, she became ill and collapsed, and while she was unconscious her beloved pet attacked her, causing facial injuries of almost unimaginable horror.

Ms Dinoire, who didn't feel the attack, said Tania had never bitten anyone before the incident, and believed that she was trying to save her.

Writing in her diary, which was published in France as an autobiography called Le Baiser d'Isabelle, or Isabelle's Kiss, she recalled: 'When I woke up I tried to light a cigarette and I could not understand why I couldn't put the cigarette between my lips - it was then that I saw a pool of blood and the dog beside it.

'I went to look at myself in the mirror, and there I could not believe what I saw - it was horrible.'

Hours later at Valenciennes Hospital she looked at her reflection, describing what she saw as 'the face of a monster'.

Lifelong treatment: Ms Dinoire, pictured being taken from the operating theatre in Lyon in a video grab from footage released by surgeons following the operation. The mother-of-two had to take powerful immunosuppressant drugs just to stop her body rejecting the transplant

Rebuilding: The graphics show the reconstruction of the nose, lips and chin with the arteries pictured red, veins are blue, nerves are yellow and muscles are dark red

She later wrote: 'The worst bit was the nose because the bone was visible.

'I asked the nurse to cover it with a bandage because the bone made me think of a skeleton, of death.'

Pioneer: Professor Jean-Michel Dubernard

On the advice of specialists at Amiens Hospital, where she was transferred, she was advised to wear a surgical mask that covered her face. The cover made her an easy target for strangers who thought she was obsessed with germs.

It was a month after the attack, in June 2005, that Isabelle was approached by Professor Jean-Michel Dubernard, who proposed making medical history by performing a face transplant.

But from the start, she struggled with the idea of taking another woman's face.

She wrote in her diary: 'I often asked about the donor. To return a body to her family without a face - it was an atrocious image in my mind.'

Three days later, however, she signed the consent form for the operation.

Scars: A photograph of Ms Dinoire's face released after the surgery. From the start, the patient struggled with the idea of taking another woman's face

World's first: Ms Dinoire was heralded a medical miracle when doctors successfully replaced her nose, lips and chin, with those of Maryline St Aubert. Above, the operation

'I had two feelings - fear that it might not work and relief that I could start to live normally again.'

Ms St Aubert was brain dead when she arrived at a hospital in Lille so her family consented to the transplant.

Professor Dubernard and Professor Bernard Duvauchelle, an oral and maxillofacial surgeon, led the team during the groundbreaking 15-hour surgery.

A triangle of face tissue from the donor's nose and mouth were grafted on to Ms Dinoire.

Surgeons had been transplanting livers, kidneys and hearts for many years, but faces are treated differently because they are seen as part of a person's identity.

Unlike other organs, face transplants are not life-saving operations. As a result, ethical committees frequently blocked them from going ahead.

Personal battle: At a press conference after the operation, pictured, Ms Dinoire admitted she struggled with her new identity. She later said the face was 'half me and half her'

But Professor Dubernard said after carrying out the operation: 'Once I had seen Isabelle's disfigured face, no more needed to be said.

'I was convinced something had to be done for this patient.'

After the transplant Ms Dinoire said she was determined to make a success of her life, learning to eat and speak and also wanting to be able to kiss.

But soon after the operation there were signs that her body had rejected the new tissue. Doctors controlled the problem by increasing the doses of the immuno-suppressants which she had to take for life.

Ms Dinoire soon regained sensation back in the transplanted face, learning to smile a year after the surgery. But she regularly suffered graft rejection.

Le Figaro newspaper reported Miss Dinoire's body had rejected the transplant last year 'and she had lost part of the use of her lips'.

And she continued to battle with psychological problems connected to the surgery.

Attention: The Daily Mail had an exclusive interview with Miss Dinoir in December 2005 when she spoke of plucking up the courage to look in the mirror for the first time after surgery

Speaking three years after the transplant, she admitted that she remained uncertain as to whose face she looked at in the mirror every day.

She said: 'It's not hers, it's not mine, it's somebody else's.

'Before the operation, I expected my new face would look like me but it turned out after the operation that it was half me and half her.'

Miss Dinoire said she had not yet worked out her new identity, adding: 'It takes an awful lot of time to get used to someone else's face. It's a peculiar type of transplant.'

While doubts might now be cast over the lasting personal effects of the transplant, the operation was 'an unquestionable surgical success', said Dr. Jean-Paul Meningaud, who heads the reconstructive surgery department at the Henri Mondor Hospital south of Paris. Some 15 similar procedures have taken place since 2005.

In 2006, surgeon Peter Butler, of the Royal Free Hospital in London, was given permission by the NHS ethics board to carry out full face transplants in Britain.

But Dr Meningaud, who has been involved in seven of France's 10 face transplants, is now arguing for suspending the procedures so that the medical community can take stock of whether the long-term benefits are worth the physical and psychological toll they take on patients.

Speaking of Ms Dinoire, he said: 'The results were very good in the medium term, but the long-term results were not so good.'

He said that face transplant recipients were having more difficulty with anti-rejection medication than doctors initially predicted, and are requiring more follow-up surgery.