Breast recosntruction with a large implant

Although this is possible, it really depends on the extent of the skin sparing mastectomy and adequacy of soft tissue coverage over the implant. Achieving a D cup may require a larger final implant that will likely be associated with a higher rate of complications. In this instance you may want to consider the autogenous tissue reconstruction or you may (not YOUR first choice)  want to contemplate a reduction on the opposite side to diminish the size of your implant on the reconstructed side.