This research explores growth and design processes to address the challenges of coral island growth, including limited land resources, low elevation, and the adverse impacts of climate change. By the year 2050, it is projected that a significant proportion of these islands will become uninhabitable, necessitating the relocation of thousands of inhabitants and exacerbating ecosystem degradation. Coral islands are dynamic and sustainable ecosystems that can self-grow, self-maintain, and self-adapt to environmental changes due to the living organisms that compose them. They are formed from sediments generated by corals, foraminifera, algae, and molluscs, and these organisms serve as protective agents for the islands, contributing to their growth, maintenance, and adaptation. However, climate change and anthropogenic pressures impact corals’ survival, thereby affecting these islands’ growth. This study draws inspiration from these living ecosystems to propose growth and design processes for expansion methods in the water. The primary objective is to explore innovative approaches for creating “Living Islands”, where living organisms, particularly corals, are integrated as fundamental components of the design process and contribute to the growth and maintenance of the islands. Specifically, this study explores eight growth processes for expanding land in aquatic environments, aiming to generate islands that promote sustainable coexistence among the natural environment, coral communities, and humans.