After John Gotti became boss in December 1985, Cacciopoli became a made member in the crew led by Gotti's son, John A. "Junior" Gotti and brother Peter Gotti. When John Gotti went to prison in 1992 and Junior Gotti became acting boss, Cacciopoli became Junior's top protegee and bodyguard. Cacciopoli allegedly received his moniker "Tommy Twitch" because he suffered from case facial neuralgia, an uncontrollable muscle spasm condition.
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