Guide to Abdominal Wall Reconstruction (AWR)

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Reviewed by the physicians of Columbia’s Plastic Surgery Team, May 2025

Abdominal wall reconstruction (AWR) is a surgical procedure to repair and strengthen the abdominal wall after a hernia or unsuccessful hernia repair surgeries.

  • An abdominal (ventral) hernia is a tear in the muscles of the abdomen that allows the intestines or other organs to push through and create a bulge.
  • This tear can cause functional issues like core instability or chronic pain.
  • AWR can help patients with recurrent hernias who have undergone multiple abdominal surgeries.

What is Abdominal Wall Reconstruction?

Abdominal wall reconstruction (AWR) is a surgery used to repair an opening in the muscles and fascia of the abdomen (hernia) and restore the function and appearance of the abdomen.

Why Would Someone Get AWR?

AWR is performed to fix issues resulting from conditions like large or recurring hernias, either from an injury or as a result of previous surgeries.

Who is a Good Candidate for AWR?

People who have a recurrent abdominal hernia,  a large hernia, structural damage, pain, or weakness in their abdominal wall may benefit from AWR.

How Is AWR Performed?

AWR is a complex surgery that may combine different strategies, based on factors like anatomy and hernia size.  These include:

Component Separation Technique (CST): The surgeon will reposition and move  the muscle layers apart to cover the opening without creating excess tension.

Mesh Repair: A flexible mesh material is used to reinforce the repair and keep it from recurring. This mesh can be made of biologic or synthetic material, and is designed to move with the muscles while providing stability.

Tissue flaps: Tissue may be taken from other areas of the body to cover the defect and reinforce the repair.

What Are the Benefits?

The abdominal muscles play an important role in many activities, from movement to breathing to going to the bathroom. So an injury like an abdominal hernia can have a severe impact on quality of life. AWR can help:

  • Restore core strength and stability
  • Avoid hernia recurrence
  • Relieve pain
  • Improve appearance by eliminating bulge cause by hernia

What Are the Risks?

As with all surgeries, AWR carries some risk of complications, including:

  • Infection
  • Bleeding
  • Blood clots
  • Pain
  • Swelling
  • Delayed healing
  • Nerve damage/numbness

In addition, AWR risks include mesh-related complications, including:

  • Fistula (connections between mesh and other organs)
  • Mesh migration (movement)
  • Fluid buildup (seroma)
  • Hernia recurrence 

How Do Patients Prepare For the Procedure?

  • Follow all instructions provided by the surgical team regarding what to eat prior to surgery.
  • Avoid taking aspirin, Advil, Motrin, or other aspirin-containing products for two weeks. If instructed, stop taking other medications in the time leading up to the procedure, as well.
  • Stop smoking to aid in healing.
  • Designate a friend or family member to assist with leaving the hospital after surgery.

Will Patients Need to Stay Overnight at the Hospital?

AWR is performed as an inpatient surgery, and will require a stay at the hospital for a few days for monitoring after surgery.

What Type of Anesthesia is Used?

AWR is performed under general anesthesia, meaning the patient is asleep for the surgery.

How Long Does AWR Take?

The surgery generally takes 3 to 6 hours, depending on the complexity of the condition.

What Is Recovery Like?

  • Patients may experience mild to moderate pain for a few weeks as they recover. The care team will help manage any pain and discomfort.
  • Patients stay in the hospital for several days for monitoring and pain management.
  • An abdominal binder may be recommended postoperatively.
  • Avoid strenuous activity, heavy lifting, or exercise for at least six weeks.

How Long Until Results Show?

There should be an immediate improvement after surgery, and the final results should be fully visible in three to six months.

How Long Will the Results Last?

AWR can last for 15 years or more with proper care. Several factors can affect the results, including:

  • Age: older patients are more likely to see a recurrence.
  • Postoperative care and following the surgeon’s instructions: avoiding strenuous activity and wearing the  abdominal binder if prescribed during recovery is key to properly healing after surgery.
  • Lifestyle behaviors: Rapid weight changes can place stress on the repair, and smoking can increase the risk of complications.
  • Previous repair surgeries: the abdominal wall muscles and tissues can weaken after repeated surgeries

Will Insurance Cover the Procedure?

AWR is a medical procedure and is typically covered by insurance.

Next Steps

If you’d like to learn more about abdominal wall reconstruction or other reconstructive procedures, our team at Columbia is here to help. Call us at (212) 305-3103 or request an appointment online. We accept a number of insurance plans, and our team can help confirm your coverage.

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This content has been created by Columbia’s Health Guide Team. Learn more about our efforts to bring you the clearest, most accurate, and most human health resources available.