Wall hung - they will sag. After talking extensively to UK plumbers and bathroom fitters who install wall hung all over the UK, they will not guarantee any work where the metal frame that hold the wall hung toilet is fixed to a wooden framed wall. IF it is in a corner, where there is less "give" they feel that is the best option, but unless these metal frames are fixed into either concrete walls or brick walls, there WILL be some give over time. They all say that if there is no brick or concrete wall option (as in my case - just stud walls) then standard back to the wall are best bet. Access difficult?? - no I do not think so. I have installed many of these in the UK and access is very easy to the cistern. It is all down to how the cistern is hid. With a bit of forethought it can all be made very accessible. All of the back to the wall toilets in the UK are SO cheap. Basic models start at 50 UK pounds - really cool ones start at around 150 uk pounds. I do not think I can even use them over in the US as they all have 4 inch soil/waste pipes. Are the USA waste pipes all 5 inch?

Thanks @sjhockeyfan325. I visited Porcelanosa who didn't have the tile, but they pointed me in the direction of Ann Sachs, who did. Success!

It may be. Here is the picture of the whole room, one I found here on Houzz. I've reached out to the builder and asked about this but haven't heard anything back yet.

haha, geez, thanks so much for the help. I've seen the short (partially hidden) one a lot before. I remember seeing it awhile back when i was shopping online in a shiny brass, but can't remember where i saw it. now i see it like all the time in architectural digest and on tv shows, but can't find it to purchase anywhere.