Tissue expansion is a tool that allows for the development of donor tissue by expansion of the tissue adjacent to the defect. This technique has evolved over the last 120 years and is commonly used in tissue reconstruction to produce additional skin coverage, such as in breast reconstruction post-mastectomy, or in conjunction with other procedures, such as 2-stage cranioplasty. The principles of tissue expansion are of great interest and have allowed for the development of numerous modern implants to aid in a variety of clinical scenarios. Here, we can explore the origins of this technique and learn of our predecessors who provided the foundations for our current practices.