Current research commonly investigates two different growth strategies, organic growth and growth by acquisitions. Studies on acquisition-based growth typically draw on cross-sectional quantitative studies of large US-based firms, treating all types of acquisitions as one mode. Our study takes a different approach, and explores different growth strategies of a smaller sample of medium-sized companies drawing on a longitudinal, qualitative design. This research design allows us to identify eight different growth modes. Thereby, we illustrate that dynamic growth processes in medium-sized firms are much more diverse and complex than commonly assumed.