Ideal reconstruction of the mandible is important for a multitude of reasons and has been and continues to be among the most common surgical challenges for reconstructive surgeons of the head and neck. Historically, pedicle flaps, such as the pectoralis major and deltopectoral myocutaneous flaps, were workhorse flaps for lower facial third head and neck reconstruction. This article outlines the relevant anatomy of the perimandibular region, reconstructive options including second free flaps, relevant workup, and complications pertaining to reoperative mandibular surgery.