Building a tertiary referral center of excellence for complex abdominal wall reconstruction is a multi-step process that requires many elements to garner and promote success. Ultimately the creation of such a center is important for continual improvement of abdominal wall reconstruction outcomes by decreasing complications, recurrences, length of hospital stay, hospital readmissions, and overall costs. Establishing a center of excellence incorporates several key components including the surgeon's desires and expertise, institutional participation, multidisciplinary collaboration, outcomes research and innovation, and financial stability. This article outlines the principal elements of building a sustainable, functional, and successful center of excellence for complex abdominal wall reconstruction.