Purpose: An implant based reconstruction is the most common post mastectomy breast reconstruction performed in Australia. Direct to implant (DTI) reconstructions are usually limited to small to moderate volumes due to high risk of complications and breast pocket control. Austin Health performs a large number of DTI breast reconstructions which challenge conventional algorithms of implant volume and timing in the setting of improved surgical techniques and innovations. Methodology: A retrospective chart review was conducted on all DTI reconstructions performed at Austin Health from 2017 to 2022. Patient and implant data points were collected. Clinical outcomes evaluated included surgical site complications while patient-related outcomes were assessed with use of the BREAST-Q questionnaire. Results: 73 patients (mean age 47, average BMI 25.2 kg/m) underwent DTI reconstruction with 114 implants (median mastectomy weight 372g, median implant size 420cc). All patients except for one had acellular dermal matrix placed (Tiloop n=87, FlexHD n=26). 63 large volume implants were used (>400cc). 13% implants had greater than 150cc positive size difference than the mastectomy weight. There are 3 implant losses and 10 capsular contractures, 9 of which received adjuvant radiotherapy. 68% patients completed Breast Q with a mean overall score 74% (67% satisfaction with breast and 76% chest wellbeing). Conclusion: DTI breast reconstruction is a viable single stage reconstructive option following mastectomy with positive patient related outcomes. Larger implant volumes can be successful with recent surgical advances to optimise the pocket and should not be a limiting factor during reconstructive planning.