I am 36DD, 158 pounds after massive weight loss, 5'7" tall, 50yo. How would you create big beautiful breasts for me? (Photo)

One of the common problems for women in your situation is that the breast skin is very stretchy after major weight loss - moreso than normal - and stretches out quickly if you put in a big and heavy implant.  Even if you do a breast lift. Some surgeons will try to avoid this stretch-relaxation problem by doing the operation in two stages - a really good lift first, and then the implant later.  Others try to reinforce the lower tissue of the breast with an ADM or some sort of internal support.Currently, the best method is not yet known, but keeping the implant smaller will be less prone to revision surgery in the future.

The goal of breast surgery is to have beautiful
breasts.Since you are already a DD, I
do not think adding 200 cc implants to take you to a DDD will make much
difference.However, what will make a difference
is aligning the areola and breast tissue over the bony prominence of the chest
wall to maximize anterior projection.I
recommend a new technique called The Ultimate Breast LiftTM.Your breast tissue is reshaped creating upper
pole fullness, elevated higher on the chest wall and more medial to increase
your cleavage.You need to change the
shape and position of your breasts and nipples.Best Wishes,Gary Horndeski, M.D.

You need a lift and an implant for volume. The scars you have from a prior lift or reduction ( not sure which you had in the past) can be accessed for the implant placement and lift. You can choose your size with your surgeons guidance.good luck

Appears as a very very conservative lift. I would re do the lift with fat grafting to improve the appearance... 

Breast surgery on a massive weight loss patient can be difficult due to the extreme laxity of the breast tissue.  To meet your expectations you may need a revision of the mastopexy and larger implants.  For every 200 cc of implant volume you will go up about a cup size.