Depends on how lazy I'm feeling and how critical the part is.
Vreg for a relatively low power PSU? usually reuse if it isn't too old. Expensive ASIC or FPGA or other esoteric or critical part? New pads all the way.
Sometimes I'll add a tiny bit of thermal paste to each side of the sil-pad too, it helps stick things in place while I fumble around with the mounting screws etc.