Bring a large pot of heavily salted water to a boil and cook the orecchiette until al dente. Reserve about 1½ cups pasta water, then drain the pasta and set aside.
Remove the sausage from the casing. Crumble and cook in a pan over medium-high heat until browned. Remove from the pan and set aside.
In the same pan, add a little olive oil if needed and sauté the shallots and garlic until softened and fragrant.
Deglaze the pan with about 1½ cups of the reserved pasta water, then add the sausage back in. Remove from heat and stir in the cream, returning the pan to a gentle simmer.
Add the semi cooked orecchiette, sausage, lemon juice, parmesan, parsley, and cracked pepper.
Blanch the broccolini separately in salty water for about 1 minute, then add it to the sauce so it stays bright green.
Simmer everything together for about 5 minutes, until the pasta is fully coated and cooked to liking.
Spoon into bowls and finish with extra parmesan, chili flakes, olive oil, and flaky sea salt.
