At 49 years old, the only reasonable treatment option is in vitro fertilization (IVF) using eggs donated from a younger woman.  There is no concern regarding your ability to carry a pregnancy and your pregnancy, miscarriage and birth defect rates would all be the same as if the egg donor was going through IVF herself.  

No, it would not.   There are many things that make gynecomastia more likely or worse, but once you get it, the only way to remove it is through surgery.

Being aware of the difficulties you are having is a very helpful step to being able to start addressing things and finding your way back to wholeness and peace in your life. When you know that the symptoms that you are having will become a barrier to your success, getting help is certainly the right thing to do. It is possible that there are options for medication that can be helpful in situations such as the one that you describe, but to determine this you would need to consult with and be treated by a psychiatrist. From the description of some of the things that this has been rooted in, you would also be advised to seek out psychotherapy to go along with the use of medication. This provides the opportunity for people who have things going on like you have described to address some of the underlying contributors to feelings of depression and anxiety as well as to develop coping techniques that will maximize your chance of success. Ideally, when this course of action is followed, the psychotherapist and psychiatrist will be able to work together and with you form a team to address everything that is going on.

Although a post-tubal ligation syndrome has been reported with pain and/or abnormal periods following tubal ligation, most doubt that it is a real condition.  Tubal reversal can restore your fertility but I wouldn’t expect it to relieve your pain.  However, other potential causes of pain, such as endometriosis or scar tissue,  may be diagnosed and treated at the time of the tubal reversal.

There are only 2 options for conceiving following tubal ligation.  Tubal ligation reversal is an outpatient surgical procedure.  Assuming a good length of normal tube and no other significant infertility factors, it will restore fertility back to normal.  The risks of bleeding, infection, damage to other organs and reactions to anesthesia are extremely low.  The other option is IVF which also has a high rate of success and avoids surgery.  However, it requires daily injections for 2-4 weeks, frequent office visits for monitoring with blood work and ultrasounds and nonsurgical procedures to remove the eggs and place the fertilized eggs into the uterus.  The risk with IVF are multiple pregnancy and over-stimulating the ovaries.  The cost to achieve a pregnancy is generally lower with tubal reversal than IVF but prices vary by provider. 

The duration from tubal ligation to reversal does not affect success rates.  The factors that are significant are the length of tubes available to repair, the site and technique of the tubal ligation, the age of the woman, and the presence of other infertility factors such as scar tissue, endometriosis or a poor semen analysis.

Fortunately, the weight loss surgery is done in the upper abdomen and the tummy tuck only involves the abdominal wall; the abdominal/pelvic cavity is not entered.  Therefore, scarring in the pelvis which could compromise the ability to perform a tubal reversal, or success rates afterwards, should not be an issue.