My dad had a second mandiblectomy after rads, but his was due to a recurrence, not for any improvement cosmetically or functionally. I don't think my dad would have considered another surgery if the cancer hadn't returned. They monitored him very closely after the surgery and I noticed they did a lot of pricking the skin to check for blood flow, and a lot more frequent Doppler checks on the flap. He had a fibular reconstruction with his first surgery and a scapular reconstruction with his second. They had to get a blood vessel from the opposite side of his neck as the vessels where he was radiated were no good. They also took skin from his back and replaced some skin on his face, where the radiation had compromised it. My dad's surgeon said they can do the reconstruction without taking bone from elsewhere on your body, but that it was sort of a last resort because of the complications. I only have my dad's experience to go by, but I am surprised your surgeon didn't do bone initially. Was there a reason why they opted to go with metal rather than bone? They told my dad if they could clear him of the cancer, he could consider doing HBO treatments should he want or need to have his remaining teeth removed. HBO lessens the odds of osteoradionecrosis, which is apparently a fairly common complication after having dental work or surgery done after rads. Until he has no cancer though, its a no go as the HBO proliferates the cancer as well as it heals wounds.