Abdominal wall reconstruction (AWR) is a specialized type of complex ventral hernia repair, typically performed by specialists who regularly perform these procedures. The field of abdominal wall surgery is constantly evolving, as are the surgical techniques used to address complex abdominal wall defects, which necessitate these procedures. This chapter will serve to review the technical options for AWR, as well as important things to consider when presented with a scenario where AWR may be a necessary option.