The central plot twist of "Real Girl" is the reason for Iroha's six-month deadline for their relationship: she has a brain tumor and must travel to the United States for a high-risk surgery that could result in her death or cause severe memory loss. This is hinted at throughout the first season but only fully revealed towards its end. Her initial attraction to Hikari is driven by her desire to form genuine, happy memories before this uncertain future.
The surgery is successful in saving her life, but it comes at the cost of her memories, specifically all of her memories concerning Hikari and their time together. This leads to a major time skip of seven years between her departure and the finale. During this time, Hikari finishes school and continues his life, faithfully waiting for her without trying to contact her, believing it's his way of not burdening her recovery. The other characters also grow up: Arisa Ishino and Mitsuya Takanashi get married and are expecting a child.
The climax of the series occurs when Iroha returns to Japan and coincidentally attends Arisa's wedding. She doesn't recognize Hikari, causing him immense pain. However, she feels a sense of emptiness and a vague familiarity. The resolution comes when she sees the matching keychain on Hikari's bag, a memento from a high school festival. This object acts as a catalyst, unlocking her suppressed memories in a flood of emotion. The final scene confirms that they rekindle their relationship, get married, and are expecting their own child, providing a definitive happy ending. This reveals the story's ultimate theme: their love was a fated connection so powerful that it could overcome even the complete erasure of memory.