Antenna tweaking and satellite receiver sites are the norm for conventional base stations and repeaters of any band, but the higher you go in frequency, the more critical the relationship between these parameters becomes. Terrain and vegetation coupled with rural/low density structure versus urban/suburban high density structures and how effective you want the in-building coverage to be are the prime considerations. Antenna types (gain factor, downtilt, propagation patterns, etc), mounting location effects on patterns, height above average terrain, feedline losses, etc. determine how well the transmitters and receivers perform in a given application. Sometimes a top mounted RX preamp is required, and sometimes multiple receiver sites are required, and sometimes lots of height and plenty of downtilt gets the job done when nothing else does. 30+ years of experience has proved to me that rarely does the no downtilt/nosebleed height antenna combo give satisfactory results unless your objective is station-to-station coverage or mobiles only with little handheld use, but it still seems to be the norm.
And I've always wondered how the bean counter who cuts the microwave link system outta the multiple receiver site plans in favor of dedicated twisted pairs thinks that saves any money. You can usually pay for the MW within about 5 years of line leases. Oh well.