Lumbar incisional hernias can be challenging to repair given the need for reliable fixation which usually involves the lateral pelvis. Bony defects in the pelvis make it difficult to achieve appropriate mesh overlap and fixation, posing a major challenge for the reconstructive surgeon. Our multidisciplinary approach to repair an incisional lumbar hernia, in the setting of a previous hemipelvectomy, is presented step-by-step in this video. A 55-year-old male with a prior history of right hemipelvis chondrosarcoma requiring resection presented to the hernia clinic with a lumbar incisional hernia. Operative strategy was planned with the collaboration of an orthopedic specialist and elective hernia repair with combined reconstruction of the pelvis by using a custom hemipelvis was offered. An open, right myofascial release was performed followed by reconstruction of the right hemipelvis using a custom prosthesis. A large piece of synthetic mesh was placed in the preperitoneal plane and it was fixated with bone anchors and into prosthetic. Patient recovery was uneventful and he was discharged on postoperative day six. A lumbar incisional hernia associated with a bony defect in the pelvis is a challenging clinical scenario. Reconstruction was achieved with good short-term results by a multidisciplinary team.