At millimetre wave the link only exists because of antenna gain. Free-space loss is far higher than at sub-6 frequencies, foliage and rain matter, and a hand or a body can end a connection. Every one of those is answered by narrow, steerable beams, which is why the antenna is an array and the array is part of the radio rather than attached to it.
That integration is the defining constraint. The array, the front-end circuits behind each element and the beamforming control are one assembly, and their spacing is fixed by wavelength rather than by convenience. There is very little room to move anything.
Thermal design then decides output power. Amplifier efficiency is lower at these frequencies, dissipation is concentrated in a small area behind the array, and the enclosure cannot grow without changing the mechanical envelope. In practice the heatsink sets what the radio can transmit.