Tissue expansion in abdominal wall reconstruction (AWR) is often overlooked as a viable reconstructive option to provide a durable and stable soft tissue and fascial coverage in massive ventral wall defects. It can provide a safe and effective means to utilize local tissue and minimize additional donor site morbidity. This chapter presents a review of tissue expansion in AWR, along with our operative technique and technical pearls for applying this approach in reconstruction. Limitations include that timing for reconstruction should be performed in a delayed approach from the original event and is a two-staged reconstruction, requiring commitment for serial expansion. Mesh reinforcement may still be required to reduce the risk of hernia recurrence.