That limitation was overcome over 20 years ago with the invention of Direct Server Return (DSR) technology, since the remote IP becomes that of the actual client. (This also helped relieve pressure on load balancers since they don't need to process return traffic.) Another way to overcome this would be to use netblocks instead of IP addresses on both the load balancers (upstream side) and the server side (so the LB has multiple IPs to connect to and the server to respond from).

The benefit of DSR became mitigated a bit after CGNAT (in the IPv4 space anyway) began to be rolled out, since it can masquerade a large group of clients behind a single IP address. (CGNAT poses other, different problems related to fraud and abuse mitigation.)