Great responses, bespoke is definitely what I'm looking for. I wasn't familiar with that term but searching it on Yelp has resulted in a number of local places I plan to check out.
I used to be able to mix and match or buy off the rack with alterations when I was a 44 or 46. I'm 6'4", 240lbs with a 50" or 52" chest and shoulders with a 36" waist. The amount of tailoring it takes to get a jacket right is crazy. Most places won't even try it. At this point price is no object - I just need a few good fitting suits.