Large breast reconstruction after double mastectomy?

After a double mastectomy, very little tissue is left. 40 DDD corresponds to 1500 cc volume. Silicone implants go up to 800 cc but it may be possible to get a something larger made. However, the weight of the implant is only held by the skin envelope and would likely descend and have complications. You would be better off with a smaller implant or combined autogenous and implant reconstruction.

Best Wishes,

Gary Horndeski, M.D.

The problem with achieving that size is getting good skin coverage of the implants. Using tissue expanders just makes the thin skin left even thinner. Flaps may be needed for that size of breasts. If you have had radiation, then that size will be too large. Go visit with a plastic surgeon and see what realistic size you can achieve. Plus, DDD's are heavy on your neck and shoulders.

Thank you for posting your question here!My answer will be limited due to the limited data and lack of pictures provided , for a detailed and personalized plan I would recommend consulting with a plastic surgeon in person.
I am sorry that you have to deal with a bilateral mastectomy and I wish you the best on your journey towards recovery. I would say that a lot goes into what can be done to reconstruct a breast , that includes the limitations of the implants ( silicone goes up to 800cc, while saline can be overfilled a little more), other factors include your frame, the health of the mastectomy flap, how much skin is left after surgery etc. I would also say that you will most likely end up having a two stage procedure with an expander first followed by an implant. You should also consider that placing a heavy implant in an area where a lot of the attachments have been taking down during the mastectomy surgery like the attachements at the inframammary fold will risk future complications like bottoming out etc.
you also have other options like having a DIEP flap or some other autologus flaps that might come with their own skin and can mitigate some of the issues with any lack of skin envelope. That being said , no matter how good the reconstruction is you will still have scars , your surgeon might be able to get the reconstructed breasts to look a lot like the way they used to look like before surgery but they will not be identical to what they looked like before and doing it safely without affecting or delaying your cancer treatment should take precedence.I hope this helps, best of luck!