Diaphragm resection requires complete reconstruction to avoid respiratory compromise or herniation of abdominal contents into the chest. Primary reconstruction of the diaphragm is often possible, even with a large defect, as long as the tissue can come together without excessive tension. Larger defects or complete diaphragm resections necessitate reconstruction with synthetic material or autologous tissue. These reconstructions can be accomplished safely and effectively by following specific surgical tenets, and require an in-depth knowledge of the diaphragm’s anatomy, innervation, blood supply, and adjacent organs.