Doctor Strange said:
Inflation is purportedly responsible for blowing the fluctuations to cosmic proportions,
Inflation only really increased the wavelengths of the fluctuations. It made it so that these tiny deviations in density occurred across all length scales. It's still gravitational attraction that allowed these tiny density differences to grow over time.
Doctor Strange said:
so we're talking about the time before inflation.
No, only during. The properties of inflation are such that almost all of the properties of the universe before inflation are erased. It literally doesn't matter if the universe was perfectly uniform before inflation, or if there were significant changes in density from place to place, as long as the properties early-on were such that inflation was allowed to get started. The basic picture is:
1. Zero-point fluctuation in the Inflaton field creates the fluctuation (the Inflaton field is the field which drove inflation, and the zero-point fluctuation means that the value of the field jumps a tiny bit due to quantum effects).
2. The fluctuation's wavelength is increased rapidly due to the rapid expansion. It soon grows large enough that it's no longer possible for a light ray to travel from the peak of the fluctuation to the trough: the fluctuation gets "frozen" and doesn't change much.
3. Inflation ends, and the expansion rate of the universe slows dramatically. The slower expansion makes it so that light rays can, once again, make their way between the peak and trough of the fluctuation. This allows gravity to start amplifying the fluctuation.
4. Over long periods of time, those initial seeds eventually grow to become all of the galaxies and galaxy clusters we see in our universe.
Doctor Strange said:
Where do the quantum fluctuations get permission to do real work? Creating a gravity differential is real work.
There's no "permission". The quantum fluctuations are just tiny shifts in the field value. Normally these have no effect, as they average to zero. But the rapid expansion during inflation prevents this, so that gravitational attraction can later allow these tiny fluctuations to grow.