Langer's Axillary Arch: A Systematic Review and Meta-Analysis of Its Prevalence and Clinical Relevance

Langer's axillary arch, also known as the axillopectoral muscle, represents a relatively uncommon anatomical variation of the axillary region. Although often asymptomatic, its presence may have important implications in surgical procedures involving the axilla, particularly during breast surgery, axillary lymph node dissection, and reconstructive procedures. Despite numerous anatomical and surgical reports describing this variation, the true prevalence of Langer's axillary arch remains uncertain due to variability in study design and detection methods.

The aim of this systematic review and meta-analysis was to evaluate the reported prevalence of Langer's axillary arch and to assess methodological variability among anatomical and surgical studies.

A systematic literature search was conducted in accordance with PRISMA guidelines using electronic databases including PubMed, Scopus, and Web of Science. Studies reporting original data on the presence or prevalence of Langer's axillary arch in cadaveric or surgical populations were included. Data extraction included study characteristics, sample size, number of detected axillary arches, and reported prevalence. A random-effects meta-analysis was performed to estimate the pooled prevalence and to evaluate heterogeneity between studies.

The analysis included studies comprising both cadaveric anatomical investigations and surgical series. Considerable variability in reported prevalence was observed across studies. Cadaveric studies generally reported higher prevalence rates compared with surgical series, reflecting differences in detection methods. Meta-analytic synthesis demonstrated that Langer's axillary arch represents a relatively uncommon but clinically relevant anatomical variation.

Langer's axillary arch should be recognized as an important anatomical variant of the axillary region. Awareness of this variation is essential for surgeons performing axillary procedures, as its presence may influence surgical exposure and lymph node identification. Further large-scale anatomical and clinical studies are needed to better define its prevalence and surgical implications.