What is the purpose for each type of incision?

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I had surgery about 6 months ago, and the doctor thought he could take care of the problem without having to make the incision under the nipple. So, he just made those two small incisions beneath each pec. And it looked okay for a couple weeks, but then the puffiness returned, and it made me wonder if he only performed the liposuction part of the procedure, and not the excision of gynecomastia, or something like that.

I’m planning on asking him about this, but I was curious what other doctors thought about this. Are there different reasons for both types of incisions (under the pec vs. under the nipple)? Is one for lipo and one for removing the actual gynecomastia? I’m worried he might not admit that the reason the gyno “came back” is because he made a mistake in thinking he could take care of it by performing just lipo or something. I wouldn’t really be upset at this point, I just want to know why it really came back instead of never being sure.

Thanks for any insight