The result adds momentum to the newly formed centre-right alliance.
The vote on the Italian island has been viewed as a crucial test ahead of next year's national election.
The 81-year-old billionaire businessman's career has been beset by scandals both in and out of government.
The four-time prime minister has been away from the political centre stage since he was expelled from parliament four years ago after being convicted of tax fraud.
Mr Berlusconi is seeking to overturn a ban that bars him from public office ahead of the spring 2018 vote. The European Court of Human Rights is set to review his case later this year.
"Sicily, just as I asked, has chosen the path of real, serious, constructive change, based on honesty, competence and experience," he said in a video posted on Facebook.
- The many trials of Silvio Berlusconi explained
- Italy's once-untouchable prime minister
- In pictures: Berlusconi in politics
The newly formed coalition brings together Mr Berlusconi's Forza Italia party with right-wing parties Northern League and Brothers of Italy.
The Berlusconi-backed candidate Nello Musumeci beat the anti-establishment Five Star Movement candidate, with just under 40% of the vote.
However, more than 50% of Sicilians did not cast a vote, according to Italian media.
Mr Musumeci said his first task was to try to reach non-voters.
The election result is a blow to the ruling centre-left government, which is already suffering politically from public anger over the country's migrant crisis.
Silvio Berlusconi: A timeline of politics and scandal
- 1986: Already a successful businessman who owns multiple companies, he buys AC Milan football club
- 1994: Resigns from his businesses, forms the Forza Italia Party and is elected Italy's prime minister. After just seven months he is forced to resign over corruption allegations
- 1996: Loses a general election to left-wing Romano Prodi
- 2001: Despite trials in 1997 and 1998 over accounting fraud and corruption, he wins a second term as prime minister
- 2005: After disappointing regional elections he dissolves government, before reforming it and being sworn back in with the same allies on the back of a ministerial reshuffle
- 2006: He loses a general election again to Mr Prodi and is ordered to stand trial for allegedly bribing British lawyer David Mills to lie under oath during 1990s corruption trials
- 2008: After the trial is moved to London and then suspended, he wins a third vote for the revamped and renamed People of Freedom (PDL) party
- 2009: The constitutional court strikes down a law that could have given Berlusconi immunity from prosecution. He survives a parliamentary vote of no confidence by three votes in 2010
- 2011: His support drains away as the country's borrowing costs rocketed at the height of the eurozone debt crisis. Amid allegations he paid for sex with an underage dancer and as earlier tax fraud trials resume, he resigns after losing parliamentary majority
- 2012: He is found guilty of tax fraud and sentenced to prison but later has jail time abrogated at appeal.
- 2013: His party comes within 1% of winning the general election but he is expelled from parliament in a vote
- 2014: The sex conviction is overturned in 2014.
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