Not too difficult when you move away from one-off, "back room" work. After all, pistons are not circular in plan nor do they have straight sides. Only by a few thou' but they are critical dimensions for maximum durability.
It is the modern capability for mass accurate machining, in many ways, that has brought us to the reliability point we are at now. My car is up to 160,000 miles, doesn't burn oil, has never had the head off and still does 50mpg. A couple of generations ago, that would have been very much the exception.