Unless there is an overriding concern, it is common to use the same incision to avoid placing a second scar on a breast when one is removing an implant. Often, a scar excision is performed when a surgeon uses the same scar location to improve the resulting scar.
It's hard to say without seeing you, but sometimes I can remove the implant through the previous incision. However, if the scar tissue needs to be remove the incision may have to be a little longer.
I typically use an infra-mammary incision. From a surgical point of view it is extremely helpful to see the implants, the capsule, muscle and ribs, if bleeding occurs you can see it well and manage it. The scar is well hidden in the crease and the incidence of tethering of the areolar incision is much less, not to mention the incidence of damaging the nerve to the nipple. When patients loose sensation to the apple they typically don't like it.
Stephen M. Davis, MD FACS
Green Hills Plastic Surgery
Regardless of the original approach, I almost always choose the periareolar approach for revision surgeries because of the added exposure and control. I never use the inframammary fold incision, either for first time surgeries or revisions. If the patient has an IMF incision and I need to do a revision, I will make a new incision in the periareolar position. If you have a peri incision, I would use that one.
If the original scar is at the areola, or the axilla (armpit), typically it's better to use the inframammary fold incision instead. There is often scarring around the nipple, and reopening it can create puckering and distortion of the nipple. Also if significant capsule or pocket work has to be done, it's better from the IMF incision. Implant removal or exchange can safely be done through the nipple incision, but there is a risk of scarring or retraction of the nipple.
Yes, it is common to suggest an inframammary incision (breast fold incision) for a second surgery if your original areola scar has already developed severe puckering. That is not unreasonable to suggest this. It will be better to have a well healed scar in the fold vs a really bad puckered scar on the areola. This being said, it is difficult to suggest anything without an in person exam. Best of luck to you
Your surgeon is making a valid point and I usually suggest that to patients, but after educating them about my thoughts and reasons,I am willing to use the old scar. They are the ones taking the risk and at least they know who to blame if they are dissatisfied with the results. (It's not the surgeon.)