I had the same problem on my M38 but decided to stick with the Pachmyers. I tried a couple of other types but they either didn't fit my hand right or I couldn't get a proper grip on them. But I have also found that even with the added grip size concealability is not an issue. The most important issue for me is being able to get a proper grip on my ccw so that I know my front sight will come to center focus in my field of vision, not off to the right or left and the added size of the Pachmyers do that just right for me.
As to mode of carry - it will vary, of course but a ccw should be immediately available and being buried under layers of clothing, sweaters, carried in a ankle holster, floating around in the bottom of a purse or completely covered by a pocket or the like doesn't lend well to immediate availability. JMTCW.