Introduction: Tissue expansion involves serially expanding an implanted subcutaneous device to stretch the skin, allowing for reconstruction of a defect using skin excess on removal of the device. Tissue expanders operate on the principles of mechanical creep, biological creep and stress-relaxation, inducing hyperplasia in the epidermis and increased collagen synthesis in the dermis. Whilst tissue expanders did not come into surgical practice until the 20th century, the concept of tissue expansion has been applied as early as 6000 BCE where African women were adorned with lip plates, a practice which continues in Ethiopia today, with the largest recorded at 59.5cm in diameter. History: In 1915, Morestin described serial excision, which applied the observation that skin could be stretched in a stepwise fashion. Subsequently, soft tissue expansion was first described by Neumann in 1957, who expanded post-auricular skin using a subcutaneous rubber balloon for reconstruction of an external ear defect. By 1967, Gibson and Kenedi articulated the biomechanical properties of skin under tension, but it was not until the 1970s, when Radovan and Austad independently developed silicone tissue expanders, that the diverse application of the technique in reconstructive surgery was accepted. Radovan presented a case series describing the technique and Austad analysed the histological changes in skin in response to tissue expanders. Conclusion: Despite initial promise, tissue expanders did not achieve widespread popularity due to prolonged expansion time with an increasingly bizarre appearance as expansion proceeds. However, the technique remains a reliable option for breast and scalp reconstruction.