Pseudonym	Pre-operative interview	Post-operative interview	Status at time of interview	Background to request for abdominoplasty	Summary of pathway to surgery and post-surgical experience	Participant responses to the question: Was it worth it?
Marielle		X	Interviewed 5 months after surgery Waited 5 years	Twins Stay-at-home mum (primary school kids)	Public Couldn’t afford private (estimated cost of $30,000) Investigated it through private system after a friend had it done, who then put her on a public waiting list	‘It was worth it. Muscles better, can wear clothes, lights on, no flappy’
Jill		X	Interviewed 6 months after surgery Waited 7 years	Weight loss Rash A bit older Two C-sections: GP advised muscles wouldn’t go back without surgery Stay-at-home mum (primary + high-school kids)	Public Found out about abdominoplasty via GP Was put on a waiting list and asked to get to a certain body mass index, which was psychologically very difficult Reason for seeking surgery transitioned from weight loss to the rash Didn’t call it ‘plastic surgery’ with some family members, emphasised medical impact and rash	‘Rash is gone, but I don’t feel better about myself. Well, some days I do, but still have some fat around my pubic area, my boobs are still huge. My clothes do fit better though’
Loretta	X	X	Interviewed 2 weeks before surgery Waited 6–7 years Re-interviewed 5 months following surgery	Long life of weight loss and gain, had gastric sleeve in 2011 (left her with a ‘sugar bag’—significant weight that presses on her bladder, bowel, blood vessels, etc.) Retired It’s ‘my time’ now	Combined with hernia repair Didn’t call it ‘plastic surgery’, emphasised the hernia repair Didn’t have private health insurance Trusted the public system, although thought some doctors don’t have enough empathy or cohesive communication at times The waiting caused a bit of anxiety Didn’t want to go private on principle (estimated $12,000) because they already contributed so much to the private sector via fees when younger: happy to make a co-payment to the public system Fell off a ladder, which further postponed the surgery Possibly found out about it via bariatric surgeon	Happy she had it done, although she feels that it has left her with a ‘seal nose’ where the scar comes together. At the time of re-interview, she was on a waiting list to be assessed for a scar revision
Zofia		X	Interviewed 2 months after surgery Waited 4–5 years	Lost 25 kg over life Felt like everyone was staring at her, went through depression Wanted a flat tummy to wear clothes more easily Relationship and intimacy issues: hides from partner when changing (remains unresolved)	Found out about surgery via a friend At initial consult was told she needed to lose another 5–6 kg, found this very motivating Was a bit nervous about the scar Had a medical incident that increased the waiting time for the surgery (postponed a second time because of urinary tract infection) Feels mental health is as important as physical health Would be open to counselling as a follow-up to reconcile poor result / incongruence with expectations	Hates it, cried through most of the interview (dog ears) Doesn’t feel psychosocial support would help because it’s the body that’s the problem, not her mind Keeps ringing up Flinders Medical Centre to see if they can do a revision
Rebecca		X	Interviewed 2 months after surgery Waited 5 years	Had twins and was quite large with significant back pain Psychological: hated her partner’s attention to her, and how she looked in the mirror Isn’t a big fan of cosmetic surgery, but wouldn’t mind some implants: can’t justify being out of pocket for it Sense of ‘deservingness’ to get the surgery because of twin pregnancy	Couldn’t justify the expenditure privately so was very grateful to get it done in public system A friend let her know about it Very assertive: got on the waitlist within 5–6 months of giving birth Happy with the waiting time, which coincided with when the kids started school: ‘my time to focus on myself again’ Found surgeon’s focus on psychological and emotional domains validated her getting the surgery done	Back pain gone Good to look down at a flat belly Still has saggy boobs Looking forward to being able to build up muscles and have a better core
Barbara		X	Interviewed 3 months after surgery Waited 3 years	Weight loss with lap banding, had a big apron of skin that was causing rashes (privately done): it was this surgeon that referred her to the public system for abdominoplasty Inefficient organisation of paperwork, appointments, etc.	Feels the surgery should not be elective or classed as cosmetic: was frustrated she had to buy her own binder (cost of $85) Couldn’t afford this surgery on the private system and can’t afford new clothes: living off the pension (in a privately owned home) Didn’t feel a need for a new belly button, but they gave her one anyway Found out about it via bariatric surgeon	Happy with majority of results although feel that there are some small dog tags on the side, will follow up on this with surgeon when possible Feels as if ‘I got my body back, and can live how I want to now’
Robyn		X	Interviewed 2 years after surgery Waited 18 months	Had the surgery after having 2 kids and lap banding done privately to lose weight ‘I’m a mum, my days of bikinis are way gone’ Couldn’t afford this surgery on the private system	Waiting time worked out ok for her as she was waiting for her kids to grow up and to move closer to her family Her sister got the surgery done privately and felt really rushed into it Found out about it via a bariatric surgeon	'The scar is hideous, and I’ve got dog ears, but I don’t have to tuck the skin in anymore and that’s really what I was aiming for’ Much happier because ‘I don’t have to tuck anything in’ ‘I’m more active with the kids’
Trudy		X	Interviewed 7 months after surgery Waited ~6 years	Long history with weight loss, plus last baby destroyed muscles Called it her ‘gunt’ that would go around with her everywhere: was significant to her that she could see her fanny when she showered again Heard about it through online and social media groups	Asked for a referral from doctor ‘to get boobs reduced and tummy tucked. Was called in for boobs 2013 and got them done 2014’ Same surgeon said she was still too overweight for tummy surgery at that time, but she lost 39 kg over next year, proving she was a good candidate, so was put back on the waiting list Couldn’t afford it through the private system	Reckons it’s the best thing she’s ever done Has improved her confidence and mental health, made it easier for her to exercise Now wants to get her arms done
Annette	X	X	Interviewed the day before her surgery Waited: 4.5–5 years Re-interviewed 5 months after surgery	Had 4 children, and was very ill during pregnancies, so developed hernias from vomiting all the time Describes the skin as flowing in the ocean during sex: affects intimacy Looking forward to closing the chapter of baby-body	Heard about it from other mums: that it was available in public system; couldn’t afford the $8000 gap on the private system Still didn’t know who her surgeon was going to be the day before: this frustrated her After the surgery was staying in a room of old men, who were vocal, and she felt humiliated Feels the surgery didn’t achieve its goals, so now is paying for private revision with gap of around $5000: describes this as stressful and is going to have to take work off, etc.	Completely regrets it, describes it as a nightmare where she is now going to have to spend thousands of dollars fixing the scar Wishes she’d never got it done, even if she was still living with the pain and discomfort caused by the hernia (which is fixed) Describes her body as feeling wrong: muscles, skin, scar, digestion, all of it
Tricia	X		Interviewed while on waiting list for surgery: no date scheduled Waited 18 months at time of interview	Had a hysterectomy that caused floppiness in her stomach Had to lose some weight to make the eligibility criteria Rural Is an entertainer: wants to wear dresses, and feels embarrassed about her floppy tummy	Gets rashes: smells and stings Interrupts intimacy: doesn’t want her partner to see it Found out about the surgery through GP when talking about her unhappiness with her body Range of caring responsibilities for her kids and their kids Doesn’t feel like counselling would be useful for her: she knows what’s going to help, to get her stomach done	N/A
Heather		X	Interviewed 6–7 years postoperative Waited 6–12 months	Had a gastric band and lost 50 kg, so had a big apron of skin (ended up being 2.5 kg removed) Almost felt worse after the weight loss because of how the skin looked and felt Friends and family thought she was crazy: had been through enough now	Couldn’t afford it on the private system (got bariatric surgery privately though) Wasn’t mentally prepared for how significant the surgery was, surprised by the size of scar Thinks counselling would have been helpful for her Found out about surgery via a bariatric surgeon Felt underprepared for how major the surgery was, especially the scar Doesn’t know what she would have done if she hadn’t had it done but also sad she had to go to those lengths to be happy	Happy with how it looked Had to have minor revisions for dog ears and the wound coming apart Met everything she expected, was more ‘psychologically effective’ than she thought it was going to be: helped her feel good about herself again
					Described suicidality in regard to how her body felt, and the need for the surgeries
Kirsty	X	X	Interviewed 2 weeks before surgery (didn’t have a date scheduled at the time but knew it would be within a year) Waited 4 years Re-interviewed 4 months after surgery	Really bad rash from apron of skin after childbirth, skin splits, smells, affects everything I do Has always hated her body and hoped this would give her more confidence as a bonus Lost 30 kg at some point	Dermatologist referred her for the surgery Never really believed it would happen until they rang her for a consult Couldn’t have afforded it on the private system. Is very grateful it’s happening Emphasised how significant the surgery is: such a significant recovery Her rash flared up everywhere on her body post-surgery, so that was frustrating, but settled over time	Area of infected skin is gone Surgery and recovery went very well Described feeling ‘normal’ or ‘human’ again Felt she couldn’t have paid for better surgery or service Despite her feeling the scar was sewn up by two different surgeons
Val	X		Interviewed while on waiting list (no date scheduled) Waited ~2 years	Weight loss with lap banding over last 5–6 years Now has a blob that bothers her (also describes herself as having batman wings which were operated on 2 years ago publicly) Feels the surgery will be good for her self-esteem	Was waiting for a long time and thought they’d forgotten about her, but then they rang her out of the blue When she went back for an abdo consultation, the surgeon was a bit mad she’d gained weight Found out about surgery via a bariatric surgeon Didn’t tell anyone about the surgery because she didn’t feel they’d approve, ‘because I’m an old bugger, but it was for me’	N/A
Lynette		X	Interviewed ~30 years after surgery	Birth and pregnancy: was full term size with her daughter at 6 months and kept growing (age 23 years) Describes being concerned with her body at 23, because it was part of her identity ‘Emerging from motherhood made me worry a bit more about my body, so I saved up the money for the surgery’	Found the surgery very painful At the time she was embarrassed to have it done, but now feels more comfortable with the decision Had a subsequent pregnancy, which the incisions coped with very well Was surprised by how significant the surgery was, the pain and scarring Re-married, had to negotiate being naked with someone again	Felt her surgery silhouette looked a lot better, but still didn’t feel comfortable to show her husband the scar and look, etc. Didn’t feel the muscles were addressed well, wasn’t able to regain tone after the surgery
Prue	X		Interviewed while on waiting list (no confirmed date) Waited 4.5 years so far	After 3 kids, her muscles hadn’t come back together Is small framed and is often asked by people how much longer it is before the next baby arrives. Finds this conversation difficult Couldn’t afford surgery on the private system Feels she can’t talk to any of her friends about it because they’re bigger than her	Was approved for full abdominoplasty based on muscle separation (had been seeing GP and physio about this) GP referred her when realising her muscles hadn’t come back together after surgery (had been attempting this for a full year, and was still able to fit 4 full fingers in the muscle gap) Surgeon based his decision for her to receive surgery around active citizenship	N/A
					Had also heard about the surgery from a social media group called Running Mums Australia
Rachel	X	X	Interviewed 2 months before surgery Waited 3.5 years Re-interviewed 4 months post-surgery	Always struggled with weight, had 2 kids (both C-sections), lost weight, had an apron that involved a rash—was eligible across several criteria but didn’t class these as medical reasons— felt there were other people who should have got the surgery before her	Works at a GP office, and one of the GPs told her she would be eligible Initial surgeon broke his elbow just before her scheduled date, but she wasn’t informed about this: surgery was delayed 6 months because of this Interrupts confidence, and is hot and sweaty and gross in summer Very understanding of the public system run around because she’s so thankful she’ll be able to get the surgery Felt everything went textbook	When she first saw her stomach after the operation she felt relief, because ‘I’m not that person any more’: the stretchy skin had gone Feels it’s benefited the family, her mental wellbeing has had positive impacts for everyone Doesn’t feel she’s wasted time, but wished this had been done ages ago so she could be who she wanted to be Back pain is gone now
					Thinking about going overseas with a friend who’s going through a divorce to get her boobs done Felt like she wasn’t as worthy as other candidates because she didn’t seem to be so severe