Ok, well, since the thread has taken this direction anyway...
Real, fake, big, small...I don't care. I only care about three things. Well, two.
First, that she is happy with what she's got. Self esteem is huge, and if there's an issue with that, there's not necessarily a whole lot you can do. Not to get into specifics, but... my last relationship partner wasn't terribly well endowed. I was perfectly happy with what she had, but she was rather self-conscious about them. The running gag from her was that they were "on vacation." It was simply not a subject that could be brought up without becoming an issue, and it was a real problem with our intimacy.
The second thing has to do with the difference between what's advertised, and what you actually get. To be honest, I don't actually care about this, but it is necessary to discuss a few things before moving on to my next point. These days there are all kinds of support garments on the market, from strictly supportive, to barely there; from simple fabric, to enough padding to make anyone look like they're smuggling water balloons. I don't care about this either. So it's an illusion, so what? I know the girl in the box at a magic show isn't actually being cut in half, but I don't enjoy the show any less. A degree of "false advertising" is perfectly fine; since there is a limit to how much enhancement a support structure can offer, the chances of unwrapping a basketball and finding a ping-pong ball are slim. The real issue with this point comes down to structural integrity, or what happens when they are left to their own natural devises.
Which brings us to the third issue; how do they behave, in the absence of their support structure? This part comes down to two factors: attachment point, and gravity.
Scenario A: Imagine pressing a pair of peeled oranges into a stretched membrane, and attaching the whole thing to your chest. Now imagine the shape that outlines the oranges…circular, right? Now gravity is going to exert a natural downward direction on them, but you can imagine that regardless of orientation, that deflection will be about the same. Flat on your back they might flatten out slightly, or on all fours they might hang a bit further away, but that's it. In an extreme case they wouldn't move at all.
Scenario B: Now imagine you've pushed your oranges a bit too far into the membrane, so that when you attach the whole thing to your chest, they don't actually make contact with your chest, but hang out in front of you. Now imagine the shape that outlines that attachment. I'll save you the trouble, it's an oval. Do a head stand and they'll be in your face; lay on your back and they'll be in your armpits; get on all fours and…well, you get the idea. Ok, take your oranges off now because you look ridiculous.
What we're talking about here is sag, and one might think that one scenario is preferable to another, but let's take another look. Imagine a chart, with size on the X access, and sag in the Y. For discussion's sake we'll give the X access a maximum of 10, and the Y a maximum of -10. In each example, the 0 line of the Y access bisects the attachment point, and the Y number represents the deflection gravity exerts when standing. Let's look at the extreme cases:
(10, -10): They're huge, and hang so low they actually point down. Good chance you're getting knocked unconscious if you're not careful. Probably best to keep these under wraps. Or wear a helmet.
(10, 0): Huge and yet seem to defy gravity. Y access could very well go into positive numbers. Welcome to silicone valley.
(1, -10): Small, yet seemingly without form; seem to be attached at the lower rib cage. Grandma at the beach in a bikini.
(1, 0): Small, perky. Barely legal. Probably best to ask for an ID.
(I apologize for the lack of a model; it would likely have been crude, not scaled properly or painted anyway, so.) Without casting judgement on anyone's personal taste, we can see that too far in any direction will take us into someone's discomfort zone.
Finally, the whole real vs. fake issue. Real ones can be just as disturbing as fake ones. A (10, -10) is a (10, -10), real or fake. Fake ones can be done extremely well, the trouble is they aren't cheap. Image is a big deal in a lot of cultures around the world these days, and if a bit of enhancement helps someone feel better about themselves, I say go for it, just spend what it takes to do it right. More relationship BS: Along with a house, cats, and a Porsche, one of the things my ex and I used to fantasize about me being able to get her one day (when she was feeling ok anyway) was a boob job. I know it wouldn't have been enough to keep us together, but if somehow I'd have been able to do that for her, it would have been a huge boost to her self esteem, and maybe we wouldn't have had so many silly arguments.
Really when it comes right down to it, these things only matter superficially. Baring existing self esteem issues, if two people are into each other, stuff like this matters very little.
Besides, you can always turn out the lights.