Here we go again with the "they must be real because American surgeons are the best in the world" argument. There is a belief amongst American surgeons that overfilled saline implants are the safest, which is why they tend to do them this way. Also, many American women actually want the fake look - Pamela Anderson has topped many women's magazines surveys as having the "most beautiful" or "most desirable" breasts. Once again, if you actually knew anything about this subject (instead of jumping to conclusions that the US must always be the best at everything) you would know this.
Because of US surgeons' habit of overfilling saline implants in the supposed interests of safety (which I personally disgaree with), and their reluctance to use silicone in the interests of safety (which I also disagree with), they actually produce, on average, the most fake looking implants in the world. Australia and the UK are both better, due to the wide availability of silicone implants. And as we know, the Japanese are masters at underfilled salines, as their market demands the most natural looking result. And like it or not, the Japanese are much more quality oriented than the US market, and they are much more willing to pay for it.
I should also point out that while smooth underfilled salines look the most natural, they certainly don't feel that way - it feels like there's a water bag floating around inside the breast, which of course there actually is. The most natural feeling implants are rough slicones, as they don't move around and silicone feels a lot more like natural breast tissue. But they look a lot firmer.