Top Surgeon Believes Lifelong Learning Leads To Safer, More Successful Results


It’s not often that you hear a world-class surgeon talk about the importance of reexamining plastic surgery techniques to provide patients with even better results. Yet, that’s exactly what Dr. James Grotting does to ensure he delivers the highest quality results in the safest and least-invasive ways.

Judging from the success of his thriving Birmingham, Alabama practice—and his consistently stellar reviews—Dr. Grotting walks the walk and talks the talk. 

“I firmly believe that we—as surgeons—can always get better,” he explains. “It’s important to evolve surgical techniques that are less invasive and less restrictive, but also result in faster recovery, decreased pain, and longer-lasting results. As new techniques become available, I believe it is crucial to rethink what I have traditionally been taught and decide if a new way is a better way.”

It’s no surprise, then, that Dr. Grotting—during his 30+ year career—has created new techniques in plastic surgery to become a leader in the field. 

This approach is evidenced by the fact Dr. Grotting was the first surgeon in the world to use the microvascular muscle-sparing free TRAM (transverse abdominal myocutaneous) flap for immediate breast reconstruction. 

We asked Dr. Grotting to explain the technique. “The free TRAM flap is a procedure that transfers a wedge of excess skin and fat from the lower abdomen—referred to as ‘the “flap’—to the chest after a mastectomy has been performed,” Dr. Grotting says. 

The tissue, he further explains, can live in its new location by restoring its blood supply through a hookup to an artery and a vein going into the flap to a donor artery and vein either under the arm or under one of the ribs. “The blood vessels are connected with suture material no bigger than the width of an eyelash,” he says. “And once the tissue is connected by its blood supply, it can be shaped into the form of a breast to match the other side or it can be divided in half and two breasts can be reconstructed.”

The revolutionary advancement of the free TRAM procedure over the traditional tunneling TRAM procedure resulting healthier tissue with less possibility of partial loss. Additionally, it also requires much less muscle to be removed from the abdomen. In the traditional tunneling approach, the Flap remains attached to the original blood supply and is tunneled beneath the upper abdominal skin to the chest and formed into a new breast mound.

Further evidence of Dr. Grotting’s desire to continually improve is a breast reduction technique called “the vertical sculpted pillar”. Dr. Grotting’s technique for breast reduction is a method that has evolved from combining several different techniques to beautifully shape breast tissue. 


“I firmly believe that we—as surgeons—can always get better,” Grotting explains. “It’s important to evolve surgical techniques that are less invasive and less restrictive, but also result in faster recovery, decreased pain, and longer-lasting results.”


“The technique is based on the concept that very large breasts are not only too wide, but that they are over projecting. This is what produces the drooping of larger breasts,” he explains. By focusing on what is left behind rather than what is removed, Dr. Grotting has developed a way of restoring high, firm, and round breasts that are natural but shaped almost like a breast implant. 

This technique is so effective because it leaves much of the tissue from the superior pole so that the desired fullness is left in the upper and inner aspect of the breasts. And all of this is done through much shorter incisions which result is much less scarring. 

Dr. Grotting’s belief in lifelong learning also extends to facial rejuvenation. He explains that his original facelift and facial rejuvenation approach involved many steps, including an extended SMAS flap, an endoscopic brow lift, a neck lift, and traditional blepharoplasty, all of which used extended incisions. 

“Now, though, patients generally want less surgery, so I rely heavily on fat grafting to produce highlights and improve surface contours on the face as opposed to more invasive surgical procedures,” he explains. His plication technique is proven to provide comparable results as the extended SMAS flap that he was using previously with fewer complications and a shortened recovery time.  “The results are natural—never pulled or over-operated,” he concludes. 

With a thriving practice, stellar reviews, many awards and, most importantly, stellar results, it’s hard to argue that Dr. Grotting’s belief in lifelong learning just might be his secret to success.



James C. Grotting, MD

Plastic Surgery
Face, Breast & Body Surgery
Birmingham, AL