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A nationwide trend toward “centers of excellence” for medical and surgical care has led to development and scrutiny of high-volume surgical specialty centers. The prevalence of hernias and the complexity of successful repair have led to the establishment of specialty practices. Herein we review and discuss the components of the successful establishment of a tertiary hernia referral center.Literature on establishment and impact of hernia specialty centers was reviewed, including the authors’ own practice. Factors and outcomes concerning the coordination, development, funding, and staffing of a hernia center were discussed and tabulated.After establishment of a tertiary hernia center or center of excellence, institutions have reported an increase in surgical case volume, hernia complexity, patient comorbidity, and the area from which patients will travel. Driving factors for this practice development are varied and include team development, improvement in patient preoperative factors, and surgical outcomes assessment, among others.Establishment of a successful tertiary hernia referral center often includes institution participation, surgical expertise, interdisciplinary collaboration, and ongoing evaluation of outcomes. Success may be marked by increased case volume and tertiary referrals, but it is most evidenced by improved patient outcomes.