Not even galaxies, but massive galaxy clusters. The spatial smoothing used for the ring image is a 2D gaussian with an equivalent width of 11 Mpc, or 37 million light years, big enough to contain all the 2000 galaxies in the nearby Virgo cluster with room to spare. That's for each point in the ring (and that's why they all look so nice and round. These astronomers are playing a statistical game where a pixel combines information from trillions of stars) It's called the Big Ring for a reason. Our own Laniakea supercluster [1], whose dimensions are bigger than anyone imagined up to a few years ago, can be tiled inside the ring several times over.
At that spatial scale, the Universe is supposed to be homogeneous. We do not have plausible mechanisms to generate structures on such a massive scale.
Regarding your analogy with a constellation, yes you can always draw arbitrary squares and triangles among bright stars. But if you had 20+ stars arranged in a circle like that ring, no one would think it was a chance projection, you would demand a physical explanation. We do in fact have such a ring around us: the Gould Belt [2], made of young stars all around the Sun. It is difficult to recognize precisely because we are inside it, and its stars are spread all around the sky. And, of course, some kind of physical explanation is invoked for this ring as well.
Moreover we do know it's an actual ring, and not some chance alignment, because we can derive the distance of each point from its redshift, and it turns out that they are all quite similar. The authors spend quite a few pages describing the 3D ring structure, showing that it's a ring only when seen from our direction, and how it would appear like an arc or a strange shape from other viewpoints. It would still be a kind of overdense structure, but maybe more difficult to recognize.
BTW the mechanism used to detect the ring is quite clever: it's not a sky image, but rather an absorption map: thousands of background quasars provide a sort of uniform illumination, and they look where this light is removed by clumps of matter.