Bring a large pot of generously salted water to a boil. Add the broccoli rabe and cook for 2 minutes until bright green and slightly tender. Using tongs, transfer to an ice bath to stop cooking, then drain well and set aside. Keep the boiling water for the pasta.

In a large skillet, heat 2 tablespoons olive oil over medium-high heat. Add the sausage, breaking it up with a spoon, and cook until deeply browned, crisp, and the internal temperature reaches 160°F (71°C) on an instant-read thermometer, about 8–10 minutes. Transfer to a plate, leaving the fat in the pan.

Lower the heat to medium. Add the remaining olive oil to the skillet, then the sliced garlic and red pepper flakes. Sauté for 1–2 minutes until fragrant and the garlic is just golden—do not burn.

Meanwhile, bring the broccoli rabe water back to a rolling boil. Add the orecchiette and cook until al dente (1 minute less than package directions). Reserve 1 cup of starchy pasta water, then drain the pasta.

Add the blanched broccoli rabe and cooked sausage back to the skillet with the garlic. Toss in the drained orecchiette and half the reserved pasta water. Cook over medium heat, stirring, for 2–3 minutes until everything is glossy and the pasta is perfectly coated. Add more pasta water if needed.

Remove from heat. Stir in the pecorino, a squeeze of lemon juice if using, and adjust salt and pepper. Transfer to a serving bowl and top with extra cheese, a drizzle of olive oil, and toasted breadcrumbs for crunch.