Hello @brschultz33 and welcome to Connect.
It is so hard to make these medical decisions, especially for surgery. I assume you have researched and asked lots of questions about adverse effects, healing time, etc. With the bone involvement I would want to know the odds of removing all the cancer in this surgery. My dad had the free fibular graft mandibular replacement back in the early 90s when it was a new treatment for invasive oral cancer. It was done at Ohio State University James Cancer Hospital and he did well after a long recovery at age 71. He was able to resume eating softer foods and had a good quality of life. He did not have radiation or chemo prior to the surgery. Unfortunately his cancer recurred underneath his tongue and after that it was palliative radiation and chemo only. I would assume that your pretreatment with radiation is standard protocol and increases chances of a cure. I believe that 30 plus years of using this surgery has to have perfected the techniques. I also have had head and neck squamous cell carcinoma (originating from the ear, not oral) for the past 11 years, and have had all my treatment at Mayo Rochester. I cannot recommend enough having at least a second opinion at a large referral center. Good luck to you and I will try to answer any other questions that you may have.

Thanx!!!

@brschultz33, I add my welcome. I moved your question about mandible reconstruction timing to this existing discussion in the Head & Neck Cancer support group.

- Mandible Reconstruction with Fibula Free Flap. Is this an option? https://connect.mayoclinic.org/discussion/mandible-reconstruction-with-fibula-free-flap-is-this-an-option/

I did this so you can read the previous helpful posts and connect easily with members like @hrhwilliam @kjwilson23 @sepdvm @city and others.

@brschultz33, what surgery have you had and when is mandible reconstruction being suggested for you?

Hello @brschultz33 When should you have the surgery? Since the question isn't "if you should" rather "when", then it is clear this needs to happen. The short answer is when it fits your schedule and that of the surgical team. I know it is a hard decision to make, going under the knife, being in hospital for a week, not getting around well for a month, etc. Not sure if you are scheduling around work or retired. I returned to work limited rather quickly but that's me, perhaps not you.
The ability to talk well or function without facial issues such as drooling within weeks after surgery may also limit your functionality with work or living in general. These things are usually temporary.
I think the biggest obstacle is having the courage to get this done. In that you are not alone. But I can pretty much guarantee that within a year after you will wonder why you didn't do this sooner. Good luck and I am here for you.