Given the many build parameters available within the VS extension, I'm not sure how to mimic a native Arduino IDE build.  I'm guessing the VM team would know.

I've reached the point of program saturation on a 32k Nano, and I'm constantly trimming back on the code size. That said, I regularly get native Arduino IDE builds that are 5-10% smaller than the VM Release build. So now I'm only using Visual Studio for the editing.

I love VM and happily paid for a license.  The editing/intellisense alone is worth the cost. And Resharper C++ works well -- excellent productivity. But a Native build configuration would make VM beyond excellent...