The general anesthesia (intravenous sedation) and the long downtime are huge. Not everyone is qualified to go under general anesthesia. Moreover, harvesting the fats is such a harsh process that leaves lots of bruising and required long downtime. The price is significantly higher than the non-surgical route. This aesthetic plastic surgery has reported deaths from bbl with a high mortality rate.
Gaining in popularity is something called the vertical lift, which involves a scar around the areola and then straight down the breast, eliminating the underneath scar. Proponents think that the shape is good, that the breast maintains a lot of projection over time without bottoming out, and that the underneath scar is avoided. I believe that many of these breasts look overly projecting to my taste, and that bottoming out can be minimized with the inverted T style pattern. I also feel that the underneath scar is rarely seen, and that the scars that are seen - around the areola and going straight down, seem relatively more visible with this technique since it requires some bunching up of the skin during closure. Understand that some of the best surgeons in the world argue with one another about this issue at meetings all the time! 
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